bluuebunny/crossref_metadata_2025 huggingface dataset:
Introduction
Authors: Medlock J M
Published: December 2008

For years the Association for the Study of Infectious Disease has held symposia on topics of importance in the field of infection. The Scottish Society has been similarly occupied behind Hadrian’s Wall. The 1974 Symposium celebrates the amalgamation of the two bodies into the British Society for the Study of Infection and it is appropriate that this Society should expand at a time when the world, as a result of high speed travel, is shrinking. There is now virtually no place on earth from which a determined traveller cannot reach this country within 24 nr. No longer is the United Kingdom protected from foreign disease by the slower forms of travel, as there is now no infectious tropical disease with an incubation period shorter than the time of an airflight to this country. That these diseases are now seen more frequently here is clear from a look at any major infectious diseases unit where an increasing proportion of the patients will be recently arrived immigrants who have become ill and have been admitted for diagnosis and treatment.
Diseases of travel, with particular reference to tropical diseases
Authors: Woodruff A W
Published: December 2008

The large amount of disease acquired by travellers demonstrates that at present travel is not safe. Study of this disease, however, indicates that travel could be made safe by the application of relatively simple precautions.

Groups of travellers particularly liable to develop illness include those on short-term business and holiday trips to the Tropics. Young persons undertaking low cost overland journeys are particularly at risk. Among the important protozoal diseases acquired by travellers are malaria, trypanosomiasis, leishmaniasis and amoebiasis and the recent recognition of Lassa fever requires noting in connection with the diagnosis of fevers among persons who have recently travelled from West Africa.

It is most important that travellers should receive information on precautions they should take in tropical regions and that doctors in temperate regions should ask patients if they have recently travelled and, if the answer is in the affirmative, tropically-acquired disease should be considered.
Diffuse pulmonary fibrosis and bilateral pneumothoraces in systemic lupus erythematosus
Authors: Richards Anthony J , Swinson D R , Talbot I C , Hamilton E B D
Published: December 2008

A case of systemic lupus erythematosus (SLE) which developed extensive pulmonary fibrosis and bilateral pneumothoraces is reported. Other features of SLE were minimal. Diffuse fibrosing alveolitis in SLE is probably more common than has previously been thought.
Pancreatitis and the pill
Authors: Mungall I P F , Hague R V
Published: December 2008

An association between acute relapsing pancreatitis and the contraceptive pill has recently been suggested (Bank and Marks, 1970; Davidoff, Tishler and Rosoff, 1973). We wish to report a further case of acute pancreatitis in a patient taking the pill. In contrast to previous cases the serum lipids were normal and the pancreatitis was severe and ultimately fatal.
Changes in skin potential level during sleep in psychiatric patients
Authors: Perkins Richard , Baker Martyn
Published: December 2008

Skin potential levels and EEG changes were recorded in eight psychiatric patients during three nights of sleep. In a balanced design each patient took amylobarbitone sodium 200 mg, chlordiazepoxide 30 mg and placebo in turn. Skin potential did not distinguish between wakefulness and sleep as measured by the EEG nor did it clearly identify individual sleep stages. However, significant differences in skin potential were found between Awake and Stage I, between Awake and REM sleep and between REM sleep and Stage III/IV. The level was lowest during REM sleep but approached that of wakefulness during slow-wave sleep. These findings are discussed in terms of changes in arousal threshold during sleep. A cautious comment is made on the possible effects of psychiatric diagnoses and drugs.
Subjective ratings of sleep quality and anxiety after placebo, drug and a food drink
Authors: Adam Kirstine , Adamson Liisi , Oswald Ian
Published: December 2008

Ten subjects (mean age 57 years) took part in a crossover study between a food drink and nitrazepam 5 mg. They rated their anxiety and sleep quality. On half the sleep laboratory nights during baseline periods subjects were given an inert pill which they were told would improve sleep. A comparison was made between the six pill and six non-pill nights for each subject. Subjective ratings revealed no significant difference attributable to the inert pill. Sleep quality was rated to have been improved during both late drug and early food drink administration. On early drug withdrawal sleep quality was rated worse than baseline.
Pancreatitis and hyperparathyroidism
Authors: Rosin R D
Published: December 2008

Three patients with acute pancreatitis were found also to have hyperparathyroidism, two of them also formed pancreatic cysts. There appears to be more than an incidental relationship between the two diseases. The importance of serum calcium estimations in patients with pancreatitis is stressed. Theories as to why these diseases co-exist are reviewed.
Serum zinc levels in corticosteroid-treated asthmatic patients
Authors: Ellul-Micallef R , Galdes A , Fenech F F
Published: December 2008

Serum zinc levels have been measured in twenty-four asthmatic patients, of whom sixteen were on long term corticosteroid therapy. They were carefully screened to exclude any concomitant disease. The non-steroid-treated asthmatics had normal serum zinc levels which ranged from 89 to 138 μg/ml. The corticosteroid-treated patients had a mean serum zinc level of 64 ± 9 μg/100 ml; this was significantly lower than normal (P = < 0·001).
Significance of elevation of the right dome of the diaphragm
Authors: Ramachandran S , Jayawardena D L N , Warakaulle M B
Published: December 2008

Elevation of the right dome of the diaphragm occurs in a small proportion of healthy young adults, and in a proportion of patients with cardiac disease, cirrhosis of the liver and gastroenteritis. Hence this radiological feature, although common in hepatic amoebiasis, should be considered in concurrence with the other clinical features in the diagnosis of hepatic disorders. The significance of an elevation in the right hemidiaphragm in diseases primarily non-hepatic in origin, although of no diagnostic importance, is of clinical interest and is discussed.
The effect of adrenergic blockade in hypertrophic pulmonary osteoarthropathy (HPOA)
Authors: Reardon G , Collins A J , Bacon P A
Published: December 2008

A case of hypertrophic pulmonary osteoarthropathy (HPOA) is described, together with synovial fluid cytology and synovial histology. A new approach to therapy is described using adrenergic blockade. The effectiveness of this regime was assessed by quantitative thermography. The successful results support the neurogenic hypothesis for the aetiology of HPOA.
Progressive systemic sclerosis and autoimmune haemolytic anaemia
Authors: Sumithran E
Published: December 2008

The development of progressive systemic sclerosis (PSS) in a patient with established autoimmune haemolytic anaemia is described. Points favouring an immunological aetiology for PSS are reviewed and discussed.
The effect of heart disease on pulmonary function
Authors: Hertz C W
Published: December 2008

In pulmonary congestion dyspnoea is due not only to an increase in elastic but also in viscous work. Increased airway resistance can be reduced in most of these cases by inhalation of adrenergic or anti-cholinergic agents. Therefore, besides bronchial mucosal swelling induced by congestion in the bronchial vessels via bronchopulmonary anastomoses, bronchospasm can take place and lead to cardiac asthma. The possible genesis of this bronchoconstriction is discussed.
Scanning electronmicroscopy of hypertrophic and keloid scar
Authors: Kemble J V Harvey
Published: December 2008

The scanning electronmicroscopic appearances of hypertrophic and keloid scar before and after treatment, mature scar and normal skin have been investigated. There is a graduation of features such as collagen orientation and fibre size which accompanies the clinical maturation from the active hypertrophic state into mature scar, a process which is hastened but not materially altered by treatment with steroid or compression-occlusion.
A ten-year follow-up of haemorrhagic proctitis
Authors: Myers A , Humphreys D M , Cox E V
Published: December 2008

Seventy-four cases of haemorrhagic proctitis have been observed during a 10-year period. Inheritance, psychological stress and constipation may be of aetiological significance. A graded therapeutic effect using roughage, salazopyrin and local steroids emphasized the necessity of using all those forms of therapy, both to obtain and maintain remission. Peripheral complications and persisting abnormal serum protein patterns were associated with a high incidence of progression of the disease beyond the confines of the rectum.
Jaundice induced by stanozolol hypersensitivity
Authors: Slater S D , Davidson J F , Patrick R S
Published: December 2008

A 66-year-old male patient developed jaundice after 7 months of treatment with the anabolic steroid, stanozolol. When the drug was withdrawn he made a full and uneventful recovery. A liver biopsy showed the histology of a hypersensitivity reaction. This is believed to be the first time jaundice has been recorded with stanozolol therapy and the first time a hypersensitivity-type jaundice has been recorded with any anabolic steroid.
Hodgkin's disease following infectious mononucleosis
Authors: Robinson T J
Published: December 2008

A case of Hodgkin's disease occurring 4 years after the onset of infectious mononucleosis is described. Persistence of symptoms, physical signs and Paul Bunnell test are noted and the possible association of persistent infectious mononucleosis and development of Hodgkin's disease is discussed.
Recurrent intussusception due to a primary colloid carcinoma of the large bowel in a child
Authors: Tehrani M A
Published: December 2008

A case of recurrent colo-colic intussusception due to a primary colloid carcinoma of descending colon with widespread lymphatic involvement in a child, is reported. The unusual mode of presentation and lack of awareness were responsible for a delay of 6 months before the final diagnosis was made. Two years after the operation the patient is well and there is no evidence of clinically detectable secondaries.
Effect of prostaglandin F2 alpha on lung mechanics in extrinsic asthma
Authors: Patel K R
Published: December 2008

In normal subjects inhalation of PGF2α produced two qualitatively different airways responses. In five subjects there was a significant fall in SGaw without change in maximum expiratory flow rates, FEV1 or CV. In contrast, the remaining three subjects showed a significant fall in flow rates and FEV1 together with a significant increase in CV while their SGaw was unaffected. PGF2α inhalation in six asthmatic patients produced a significant fall in maximum expiratory flow rates, FEV1 and SGaw. These patients showed a dual response with individual variability in magnitudes of changes. It is suggested that differing responses may reflect the balance between the sympathetic and parasympathetic nervous controls of the airways, and that the diminished β-receptor activity in asthmatic patients may account for heightened bronchoconstrictor response to inhaled PGF2α both centrally and peripherally in the bronchial tree.
Ophthalmic Graves' disease in monozygotic twins
Authors: Thornham J R , Nutt J E , Clark F
Published: December 2008

A pair of identical female twins with ophthalmic Graves' disease is described. Monozygosity was confirmed by analysis of blood groups and red cell isoenzymes. Thyroid status was assessed by standard tests (serum thyroxine (Thyopac-4), protein-bound iodine, Thyopac-3 and thyroid uptake of 131I). In addition, serum triiodothyronine and the response in thyroid stimulating hormone to thyrotrophin releasing hormone was measured. Circulating autoantibodies to thyroid tissue were detected in both sisters by complement fixation and immunofluorescence methods but long acting thyroid stimulator was not found.
A case of associated thyrotoxicosis and phaeochromocytoma. A diagnostic problem
Authors: Snow M H , Burton P
Published: December 2008

A case of phaeochromocytoma and thyrotoxicosis occurring in the same patient is described, in which the similarity between the signs and symptoms produced by the two conditions delayed full diagnosis until post mortem. The mechanisms involved in the production of these signs and symptoms are discussed.
Arterial surgery in pseudoxanthoma elasticum
Authors: Carter D J , Vince F P , Woodward D A K
Published: December 2008

A 25-year-old female with pseudoxanthoma elasticum was referred with disabling ischaemia in one lower limb. She had suffered from peripheral vascular disease from the age of 15. Reconstructive arterial surgery was successful.
Osteomalacia associated with increased renal tubular resorption of phosphate (hypohyperparathyroidism)
Authors: Kanis J A , Walton R J
Published: December 2008

A 12-year-old girl, who presented with joint pains, was found to have hypocalcaemia, hyperphosphataemia due to increased renal tubular reabsorption, increased serum alkaline phosphatase activity, and osteomalacia. These features, which resemble those found in so-called hypohyperparathyroidism, were all rapidly reversed by small doses of cholecalciferol.
Diffuse vasculitis, eosinophilia, and elevated antibody titre to measles virus
Authors: Bucknall R C , Doshi R
Published: December 2008

In the original description of serum sickness by Von Pirquet and Schick (1905) vasculitis was described as a feature. This was subsequently shown to be due to circulating immune complexes, which are known to be eosinotactic. The following report describes a case of serum sickness, occurring in a 14-year-old boy, characterized by diffuse vasculitis with communicating hydrocephalus and accompanied by a pronounced eosinophilia. A significantly raised antibody (IgG) titre to measles virus was demonstrated in his serum and indicated that this agent probably provided the initial antigenic stimulus.
Granulomatous gastritis, iron deficiency, vitamin B12 malabsorption and immunoglobulin deficiency
Authors: Woolf I L , Dymock I W , Shahani R T , Otridge B W
Published: December 2008

A 24-year-old male with recurrent iron deficiency anaemia was found to have a generalized reduction in his immunoglobulin levels, granulomatous gastritis and impaired vitamin B12 absorption corrected by Intrinsic Factor.

There is discussion of the possibility that cell mediated mechanisms may have been involved in the cause of the vitamin B12 malabsorption.
Myasthenia gravis and breast carcinoma—a case report
Authors: Hancock B W
Published: December 2008

A case of true myasthenia gravis, involving brain stem innervated muscles, occurring in a patient with breast carcinoma is described. Treatment with cholinesterase inhibitors gave good sustained improvement despite dissemination of carcinoma.
Aplasia of the right lung and calcifying epithelioma in association with Goldenhar's syndrome
Authors: Kenawi M M , Dickson J A S
Published: December 2008

A case of Goldenhar's syndrome (oculoauriculovertebral dysplasia) with the rare association of aplasia of one lung is presented with a discussion of the clinical findings and the aetiology. The major abnormalities, pulmonary, renal and the undergrowth of the jaw were all right-sided, confirming previous reports. This child developed a calcifying epithelioma and this is cited as support for the theory of the origin of these lesions from epidermoid cysts.
The role of epidemiological surveillance in the immunoprophylaxis of influenza
Authors: Pereira M S
Published: December 2008

A considerable amount of background epidemiological information is required for a rational approach to influenza vaccination. This is discussed and illustrated with tables and figures. Examples are given of the variation of the various strains and the problem of anticipation and prediction of epidemics discussed.
Protective efficacy of a live, attenuated, influenza virus vaccine (‘Alice’ strain)
Authors: Prinzie A , Delem A , Huygelen C
Published: December 2008

Animal studies have indicated the high degree of efficacy and broad protection of ‘Alice’ vaccine against various heterologous H3N2 influenza virus strains.

Similarly, challenge studies carried out in volunteers have confirmed the high degree of efficacy of ‘Alice’ vaccine versus homologous and heterologous influenza A virus strains.
Epidemiological studies concerning choice of population for immunoprophylaxis of influenza
Authors: Niculescu I T I , Zilisteanu E , Cretescu L , Crainic R , Oprescu E , Matepiuc M
Published: December 2008

Epidemiological studies in naturally infected persons have shown that there is a significant relation between antibody levels to the current circulating virus and morbidity. Serological findings and morbidity data suggest: (1) that the serological survey is a more sensitive indicator for influenza outbreaks than is the clinical diagnosis and (2) that the 5-14 age group is first affected when an epidemic of influenza starts off. Consequently, school children may be the major source of influenza into family units and, therefore, among older segments of the population.

Exploring the relationships between influenza morbidity and natality, as well as influenza morbidity and mortality under 1 year of age, values of <0·001 (Student's t-test) were obtained. The linear regression analysis showed that both relationships were represented as straight lines.

From the results it seems logical to utilize the available vaccine for the protection of infants, school children and pregnant women. The vaccine-induced protection can offer significant, although not total, protection of the whole population and prevent obstetrical accidents.
Spontaneous splenic rupture and pseudo-hyperkalaemia in chronic lymphatic leukaemia
Authors: Wilson Kenneth S
Published: December 2008

Two unusual complications are described in a patient who had chronic lymphatic leukaemia. Spontaneous rupture of the spleen occurred and was related to subcapsular infarction and haemorrhage. The possibility of this complication should always be considered when signs of an acute abdomen develop in a patient with leukaemia. The phenomenon of pseudo-hyperkalaemia was demonstrated. This was most likely due to increased leucocyte fragility in vitro.
Pneumococcal antigen in pneumonia. A post-mortem study with the histological and bacteriological findings
Authors: El-Refaie M , Tait R , Dulake C , Dische F E
Published: December 2008

Pneumococcal capsular antigens can be detected in lung tissue by counter-current immunoelectrophoresis even when, following antibiotics, post-mortem bacterilogy suggests that Escherichia coli has replaced pneumococci. The results suggest that antipneumococcal therapy would benefit at least 55% of patients critically ill with lung infection and that the potentially toxic drugs directed at coliform bacteria may be unnecessary.
Acute coronary insufficiency with normal coronary arteriograms
Authors: Lawson R M , Rosch J , Rahimtoola S
Published: December 2008

Two patients presenting with apparent symptomatic and electrocardiographic evidence of acute coronary insufficiency and found to have normal coronary arteriograms are documented. The patients remain symptom free at follow-up 9 and 14 months later although one requires 160 mg propranolol daily. The electrocardiographic, myocardial metabolic and haemodynamic data in 413 patients with angina and normal coronary arteriograms are reviewed and the suggested aetiologies documented. Follow-up of patients in these series indicates a good prognosis for symptom-free survival.
Pulmonary oedema during treatment of acute water intoxication
Authors: Maclean D , Champion M , Trash D B
Published: December 2008

Acute water intoxication with deepening coma and uncontrolled epileptiform seizures in a 25-year-old previously fit male schizophrenic was treated with hypertonic (2 N) saline and a 20% mannitol solution. This improved his neurological state but precipitated severe pulmonary oedema. Intravenous frusemide increased his urinary output sufficiently to clear the pulmonary oedema. In acute water intoxication the use of hypertonic solutions may thus precipitate left heart failure by expanding the intra-pulmonary blood volume beyond the capacity of even a healthy left ventricle to compensate. Simple water restriction will produce a slower but perhaps safer improvement.
The development of isolators
Authors: Trexler P C
Published: December 2008

A series has been developed of closed-system isolators which provide patients with the same effective control of microbial infection as is possible in the laboratory animal. These isolators are used to protect susceptible patients from exogenous infection as well as to prevent the spread of dangerous pathogens from infected patients. The six models of isolators are designed for use in operating theatres, or on the wards and to transport patients.
Problems of protection against virus B hepatitis
Authors: Polakoff Sheila
Published: December 2008

Various methods have been employed to reduce hepatitis B infections among patients and staff at high risk. Routine screening tests of all blood donors for hepatitis B surface antigen has reduced post-transfusion hepatitis B. After a control and prevention programme was instituted hepatitis B cross-infection was eliminated from haemodialysis units in Britain. Prophylaxis with specific immunoglobulin reduced attack rates of clinical hepatitis B, after accidental inoculation with infective material, to about 2%. Endemic hepatitis B in hospitals for the mentally subnormal remains a problem.
A case of subacute bacterial endocarditis treated with parenteral clindamycin (clindamycin-2-phosphate)
Authors: Freeman R , Roberts D W
Published: December 2008

A case of subacute bacterial endocarditis which was due to an α-haemolytic streptococcus is described. A therapeutic dilemma arose when the patient developed a drug fever to penicillin and was found to be allergic to cephalosporine. Oral clindamycin was used, but had to be abandoned since severe exacerbation of an unsuspected duodenal ulcer resulted. The patient was finally successfully treated with clindamycin-2-phosphate, a new injectable form of the drug, and the success of this therapy is documented.
Current problems in the measurement of gastrin release. A reproducible measure of physiological gastrin release
Authors: Russel R C G , Bloom S R , Fielding L P , Bryant M G
Published: December 2008

The interpretation of gastrin release is confused because of variation in the technique of the radioimmuoassay of gastrin, the lack of a standard stimulus for the release of gastrin and diversity in the method used to express the results. These problems have been analysed (a) by examining the cross-reactivity of three gastrin antisera and using each of the antisera to measure basal gastrin levels in fasting normal subjects, duodenal ulcer and post-vagotomy patients; (b) by determining a satisfactory stimulus for gastrin release in normal subjects; (c) by examining the results to determine the best method of presenting the data. The different a ntisera used were found to give different levels of plasma gastrin in the same sample of plasma. This was not related to the cross reactivity of the antisera. An English breakfast was found to be the most satisfactory stimulus for the release of gastrin. The expression of the results of such a stimulus of gastrin release was affected least by assay variation when the incremental integrated gastrin response was used. It is concluded that the incremental integrated gastrin response to an English breakfast is a satisfactory method for exploring variations in gastrin release.
Caroli's disease with intrahepatic gall-stones and salmonella infection
Authors: Hamlyn A N , James O F , Douglas A P , Lavelle M I , Venables C W
Published: December 2008

At operation for small bowel intussusception, a 26-year-old man was found to have an enlarged liver and spleen. Subsequent investigations suggested bile passage infection associated with numerous intrahepatic gall-stones but symptomatic cholangitis did not present until 5 months later. Retrograde cholangiography showed cavernous ectasia of the bile ducts which contained gall-stones.
Nephrotic syndrome, sickle-cell disease and pregnancy
Authors: Smith Alan M
Published: December 2008

A young West Indian with sickle-cell disease and the nephrotic syndrome in the last trimester of pregnancy was treated after admission to hospital with folic acid and blood transfusion. Labour was induced by intravenous prostaglandin E2 but the fetus died. The nephrotic syndrome resolved but the proteinuria, the cause of which it is suggested is a true sickle-cell nephropathy, persisted.
Prolonged nasogastric tube feeding in critically ill and surgical patients
Authors: Woolfson A M , Saour J N , Ricketts C R , Pollard B J , Hardy S M , Allison S P
Published: December 2008

Fifteen patients with varying diagnoses were fed via nasogastric tubes for between 7 and 41 days using a feed consisting of Caloreen (a glucose polymer) and Albumaid (a beef serum hydrolysate) with vitamin and mineral supplements. The feed proved nutritionally adequate and relatively free of complications. Diarrhoea was seen only in those patients receiving antibiotics by the nasogastric route. Codeine phosphate abolished this symptom in all patients. The constant drip method of administration proved efficient and time saving. Unlike prepacked preparations, the feed could be varied in composition to suit the clinical situation. This was of particular advantage in the intensive care context. The feed was relatively inexpensive.
A blood pressure clinic in a health centre
Authors: Beevers D G , Duncan S , Nelson C S , Padfield P L
Published: December 2008

Following a screening survey for hypertension in Renfrew, a blood pressure clinic was established in a health centre. Three hospital doctors, each working an average of two sessions weekly, saw 368 patients. A specially trained nurse played an important part in the running of the clinic. Attendance of patients was high, and defaulting amongst those needing treatment was low. Blood pressures were well controlled in 75% of the patients. The clinic has proved an acceptable method of managing large numbers of hypertensives without reference to hospital.
Antidepressant blood levels in acute overdose
Authors: Hallstrom C , Gifford L
Published: December 2008

Plasma antidepressant levels and clinical condition were measured sequentially for at least 24 hr in eight patients who presented with acute antidepressant overdosage. There was no evidence to suggest that a knowledge of the drug plasma levels had anything to offer in the management of a patient whose overdose included a tricyclic antidepressant.
The empty sella syndrome
Authors: Sachdev Y , Evered D C , Appleby A , Hall R
Published: December 2008

The empty sella syndrome (ESS) presents a varied clinical and radiographic picture. It may remain asymptomatic or may stimulate an intrasellar growth thereby causing diagnostic and therapeutic problems. An air encephalogram (AEG) is required for diagnosis. The purpose of this paper is to review the clinical and radiological features of the ESS and to discuss the pathogenetic mechanisms involved.
Familial anglo-oedema—a particularly severe form
Authors: Bosley A R J
Published: December 2008

A case of hereditary angio-oedema is described together with the family history and manifestations in the father of the patient. The problems encountered in his management are discussed, including tracheostomy and genetic counselling.
Emergency myocardial revascularization
Authors: Dubost Charles , Deloche Alain , Carpentier Alain , Relland John , Sellier Philippe , Vial François , Piwnica Armand , Fabiani J Noel
Published: December 2008

From 1969 to 1975, 175 patients with acute coronary insufficiency underwent emergency saphenous vein aorto-coronary bypass grafting (SVBG). The patients were divided into two groups: group I, unstable angina (165 patients) and group II, acute evolving myocardial infarction (ten patients).

In group I, the hospital mortality was 8-4%, the incidence of post-operative myocardial infarction was 10-3%. Long-term follow-up was obtained for an average of 25 months, functional improvement was definite in the majority of the patients and actuarial survival curves show 87% patients alive at the end of 48 months.

In group II, the hospital mortality was 30%; seven of ten patients had good results.
Does coronary surgery prolong life in comparison with medical management?
Authors: Rosati Robert A , Lee Kerry L , Mittler Brant S , McNeer J Frederick , Behar Victor S , Margolis James R
Published: December 2008

This analysis attempts to utilize natural history controls to answer the question as to whether coronary surgery prolongs life in comparison to medical management. Selected natural history studies are compared and contrasted in an effort to obtain an average survival curve for patients with coronary artery disease comparable to those presently being operated. The Duke University Medical Center series of concurrent operated and non-operated patients is reviewed to demonstrate the difference of prognosis of patients with coronary artery disease and the complexities involved in answering the question. It is concluded that, on average, coronary surgery does not prolong life in comparison to medical management over the span of 2-5 years. There may be certain higher risk patients whose lives may be prolonged by aortocoronary bypass surgery but more patients and more prolonged follow-up are needed fully to answer the question.
Recommending coronary artery surgery: refining judgement through application of new knowledge
Authors: Goodwin J F
Published: December 2008

An analysis is made to help decide on the best form of treatment for atherosclerotic coronary disease. Available data on surgical treatment are reviewed with emphasis on prognosis and management of the patient with stable angina.
Alpha-chain disease in an Englishman
Authors: Wang S W S
Published: December 2008

Eighty cases of the gastro-intestinal form of alpha-chain disease had been reported up to the time of writing this communication (September 1975). All patients were non-Caucasians. This report presents a case of this in an Englishman who became ill whilst working the tropics. His clinical features and response to therapy were entirely in line with the other cases so far reported.
Double-blind comparison of verapamil and practolol in the treatment of angina pectoris
Authors: Fagher B , Persson S , Svensson S E
Published: December 2008

In thirteen patients with coronary insufficiency and angina pectoris the therapeutic effects of verapamil, 80 mg three times/day and practolol, 100 mg three times/day, were compared and tested against placebo in a double-blind cross-over fashion. Verapamil proved to be the most efficient drug as regards attack frequency and glyceryl trinitrate consumption as well as physical working capacity, bringing about a statistically significant increase of the exercise tolerance as compared to placebo after a treatment period of four weeks. Verapamil is a good alternative to beta-blockers in the prophylactic treatment of angina. Possible modes of action of verapamil in angina pectoris are discussed. The study had to be interrupted because of the reports of side effects of practolol, explaining the small number of patients.
Oxyphenbutazone-induced goitre
Authors: Lane R J , Clark F , McCollum J K
Published: December 2008

A woman who had taken oxyphenbutazone for 4 years because of back pain presented with goitre and hypothyroidism. This was shown to be due to an organification defect, caused or aggravated by oxyphenbutazone.
Coeliac disease and goitre
Authors: Robinson T J
Published: December 2008

Two cases of coeliac disease associated with thyroid enlargement are presented. One had a large simple adenomatous goitre which was removed surgically and the other had histological confirmation of lymphadenoma (Hashimoto's disease).
Systemic lupus erythematosus, Sjögren's syndrome and glomerular nephritis
Authors: Sobel J D , Talor Z , Alroy G , Lichtig C , Valero A
Published: December 2008

The combination of systemic lupus erythematosus, Sjögren's disease and severe diffuse glomerular nephritis has only rarely been reported. A 14-year-old girl is described with lupus nephritis in whom co-existent clinical and histological features of Sjögren's syndrome were found. These include bilateral parotid enlargement, xerostomia, increased serum amylase, reduced salivary secretion and lymphocyte infiltration of both salivary glands and kidneys. The co-existence of systemic lupus erythematosus with Sjögren's syndrome is discussed together with a consideration of pathogenesis.
A comparative study of dextran-70, warfarin and low-dose heparin for the prophylaxis of thrombo-embolism following total hip replacement
Authors: Barber H M , Feil E J , Galasko C S , Edwards D H , Sutton R A , Haynes D W , Bentley G
Published: December 2008

In a randomized, controlled clinical study, dextran-70, warfarin, or low-dose heparin were administered to patients undergoing total hip replacement on one surgical unit in an attempt to prevent deep venous thrombosis and pulmonary embolism. Calf vein thrombosis was detected by the 125I-fibrinogen uptake test. None of the methods prevented calf vein thrombosis (dextran-70, 51%; warfarin, 58-6%; heparin, 52-6%). Pulmonary embolism was completely prevented in patients treated with warfarin but occurred in 4% of patients treated with dextran-70 and 15-5% of those treated with low-dose heparin. The incidence of complications of therapy was small and comparable in each group. It is suggested that calf vein thrombosis is a frequent and in itself a non-serious complication of total hip replacement surgery and that emphasis might be placed more usefully on prevention of pulmonary embolism.
Neonatal barbiturate withdrawal
Authors: Blumenthal I , Lindsay S
Published: December 2008

An infant with neonatal barbiturate withdrawal syndrome is reported. The clinical features, diagnosis and treatment of this condition are discussed. A retrospective review of fifty-three infants of barbiturate-treated epileptic mothers indicated a high incidence of "jitteriness" (17%) and feeding problems (36%) in the immediate neonatal period.
Acute leukaemia during azathioprine therapy
Authors: Gilmore I T , Holden G , Rodan K S
Published: December 2008

Various tumours, in particular lymphomas, have been reported in association with azathioprine treatment, both after renal transplantation and in other conditions. A case is reported here of acute myeloid leukaemia associated with azathioprine therapy for rheumatoid arthritis, and this is now the third case reported in the world literature of leukaemia arising during azathioprine therapy for a non-malignant condition.
Barbiturates and serum calcium in the elderly
Authors: Young R E , Ramsay L E , Murray T S
Published: December 2008

In a retrospective study, based on a biochemical survey of people aged 65 and over in a general practice, subjects taking a barbiturate preparation for indications other than epilepsy had a significantly lower serum calcium concentration than did those taking nitrazepam or diazepam. Ordinary doses of barbiturate may adversely affect vitamin D metabolism in the elderly.
Spontaneous rupture of the abdominal aorta
Authors: Williams T G
Published: December 2008

Fatal spontaneous rupture of the lower abdominal aorta in a previously healthy 61-year-old woman is reported; the possibility that she had the Ehlers-Danlos syndrome is discussed.
Lysozyme: a brief review
Authors: Mir M A
Published: December 2008

Serum lysozyme (muramidase) estimation is a simple, convenient and useful laboratory investigation. A review of the literature shows that lysozyme has been implicated as an aetiological factor in various disorders, and credited with being a prognostic indicator in acute myeloid leukaemia, but these promises have not been fulfilled. This low molecular weight protein is found in the urine of some patients with renal tubular disorders, but some workers have emphasized its importance as a causal agent in hypokalaemia of acute myeloid leukaemia. Research should be concentrated on muramidase as an expression of cell functions rather than as an aetiological factor. Hypokalaemia in acute myeloid leukaemia may be caused by an unidentified substance of molecular weight similar to that of lysozyme.
Cardiac tamponade and acute renal failure following Salmonella agona pericarditis
Authors: Webster J , Petersen J , Edward N
Published: December 2008

A 19-year-old female presented with cardiac tamponade complicated by acute renal failure. Salmonella agona was cultured from pericardial aspirate after repeated pericardiocentesis in several sites. Treatment with ampicillin and intermittent haemodialysis led to complete recovery.
Portal hypertension in a patient with chronic myeloid leukaemia
Authors: Foadi M D , Shaw S , Paradinas F J
Published: December 2008

A patient with chronic myeloid leukaemia treated with busulphan for 4-5 years, developed signs of busulphan toxicity and portal hypertension with ascites, oesophageal varices and jaundice. At post-mortem there was minimal leukaemic infiltration but there were alterations in the liver architecture sufficient to explain the portal hypertension. The pathogenesis of the liver changes and their possible relationship to splenomegaly and busulphan toxicity are considered.
Inappropriate anti-diuretic hormone (ADH) secretion in association with carcinoma of the bladder
Authors: Kaye S B , Ross E J
Published: December 2008

A case of carcinoma of the bladder complicated by the syndrome of inappropriate anti-diuretic hormone secretion is reported. Management of the syndrome is discussed.
Non-African Burkitt lymphoma presenting as dysphagia
Authors: Pitts J R , Cowley A
Published: December 2008

Cases of non-African Burkitt lymphoma are rare, but the clinical manifestations of this and the African type are similar. The authors believe that this patient is the first described presenting with dysphagia without intrinsic gastrointestinal disease.
Valvar aortic stenosis with unusual features
Authors: Raj M V J , Bennett D H , Fleming H A
Published: December 2008

This case report documents the co-existence of valvar aortic stenosis and hypertrophic obstructive cardiomyopathy with systemic hypertension and calcific mitral annulus, a combination which has not hitherto been reported. It is the purpose of this paper to help assess the true incidence of the co-existence of aortic stenosis and hypertrophic cardiomyopathy.
Hypocalcaemia and convulsions
Authors: Gupta M M , Grover D N
Published: December 2008

Hypocalcaemia may manifest with tetany, convulsions and even status eqilepticus. Recognition of underlying hypocalcaemia in convulsions is mandatory because the fits may not be adequately controlled by anti-convulsant drugs which may also aggravate hypocalcaemia. Vitamin D, by relieving hypocalcaemia, reduces the frequency of convulsions and may even eliminate them.
The non-invasive recognition of left atrial enlargement: comparison of electro- and echocardiographic measurements
Authors: Ikram H , Drysdale P , Bones P J , Chan W
Published: December 2008

The aim of this study was to compare the ability of electro- and echocardiography to detect enlargement of the left atrium. Seventy-four patients, divided into three groups (eighteen normal, thirty-six valvular disease, twenty hypertension and/or coronary artery disease) were studied. The P wave terminal force in lead V1 (PTF-V1) was measured from a standard 12 lead electrocardiogram, and the internal left atrial dimension (LAD) was measured from time-motion echocardiograms. Linear regression analysis showed a small but significant linear correlation between PTF-V1 and LAD (r = 0-32, P less than 0-01). Both methods would separate patients with diseases known to cause left atrial enlargement from normals, but echocardiography showed greater "specificity" (100% v. 94+) and "sensitivity" (75% v. 67%). It was much superior to the ECG in detecting milder grades of left atrial enlargement and for following serial changes.
A non-invasive test for receptor binding applied to nephrogenic diabetes insipidus
Authors: Britton K E , Tedder R S , Khokhar A M , Brown N J G , Davison A , Slater J D H
Published: December 2008

Studies in animals have determined the importance of specific receptors to the action of many hormones and drugs. In man, a non-invasive external counting technique has been used and absence of receptor function has been demonstrated in a patient with nephrogenic diabetes insipidus using radioactively labelled arginine vasopressin. This is in contrast to the findings in a patient with pituitary diabetes insipidus and a normal control. These results suggest a model for the study of hormone and drug kinetics in man avoiding multiple samplings of biological fluids.
Methylprednisolone pulse therapy in the treatment of polyarteritis nodosa
Authors: Neild G H , Lee H A
Published: December 2008

Two cases of lung granulomata associated with ‘crescentic’ glomerulonephritis both in a clinical setting of polyarteritis nodosa were treated with high doses of intravenous methylprednisolone (‘pulse therapy’) in single injections of 30 mg/kg body-weight. In the first case rapidly progressive glomerulonephritis with 100% crescents was arrested and followed by improvement of renal function from a creatinine clearance of 5 ml/min to 30 ml/min; in the second case multiple lung granulomata of 8 months' standing, unresponsive to oral steroids, disappeared 8 days after treatment with high dosage intravenous methylprednisolone.

The use of ‘pulse therapy’ with methylprednisolone is advocated, not only in such cases where arteritis is known or suspected, but also in radidly progressive glomerulonephritis associated with crescents.
Leuco-erythroblastosis following withdrawal from glucocorticoid therapy
Authors: Trenchard P M , Wells C E , Jarriwalla A G
Published: December 2008

Leuco-erythroblastosis has many known associations (Burkett, Cox and Fields, 1965; Weick, Hagedorn and Linman, 1974; Retief, 1964), but the only ones related to drug therapy are the well established response to haematinics (Burkett et al., 1965) and one possible case following anti-epileptic therapy (Retief, 1964). The case described below is of leuco-erythroblastosis following steroid withdrawal in a young man with primary polymyositis.
A case of paraparesis due to extramedullary haemopoiesis in HbE-thalassaemia
Authors: Mihindukulasuriya J C , Chanmugam D , Machado V , Samarasinghe C A , Kynoch P A M
Published: December 2008

A 24-year-old female with haemoglobin E-thalassaemia who presented with paraparesis of 18 months' duration was found to have spinal extradural extramedullary haemopoietic tissue extending from T4 to T9. Complete neurological recovery followed laminectomy. The importance of prompt diagnosis and treatment, of this unusual complication of extramedullary haemopoiesis, before the spinal cord is irreversibly damaged is stressed.
A case of Bacillus cereus bacteraemia
Authors: Barnham M , Taylor A J
Published: December 2008

A case is presented of Bacillus cereus bacteraemia in a patient receiving hepatic perfusion with 5-fluorouracil (5FU) for metastasis from a carcinoma of the breast. The literature concerning systemic B. cereus infections is briefly reviewed.
Carcinosarcoma of the adult kidney
Authors: Rao M S , Lotuaco L G , McGregor D H
Published: December 2008

Carcinosarcoma of the adult kidney is a very rare tumour and there are only a few well documented cases in the literature. In this report such a tumour is described from a 50-year-old white male, which progressed very rapidly with widespread metastases. Histologically, the tumour consisted of renal cell carcinoma and fibrosarcomatous components. The interesting features in this case were that both the carcinomatous and sarcomatous elements of the tumour exhibited metastases separately to various organs.
Co-existent eosinophilic gastroenteritis and hypothalamic-pituitary dysfunction
Authors: Haeney M R , Wilson R J
Published: December 2008

A case of eosinophilic gastroenteritis in a 42-year-old man is described. The patient had diarrhoea, faecal blood loss, a protein-losing enteropathy, malabsorption of fat, xylose and vitamin B12. Co-existent hypopituitarism, diabetes insipidus and hypothalamic dysfunction was demonstrated. Complete clinical recovery occurred with pituitary replacement therapy alone. The association of this endocrine abnormality with the picture of eosinophilic gastroenteritis has not previously been described.
Endomyocardial firbrosis and Löffler's endocarditis parietalis fibroplastica
Authors: Olsen E G
Published: December 2008

The morphological features of endomyocardial fibrosis and Löffler's endocarditis are described. Sixteen cases of the chronic stage of Löffler's endocarditis were compared with pathological material of thirty-two patients with endomyocardial fibrosis. No morphological differences were noted. It is suggested that endomyocardial fibrosis and LOffler's endocarditis are part of the same disease spectrum, the origin of which can be traced back to the presence of eosinophils in the myocardium.
The general practitioner's information requirements in prescribing
Authors: Dingwall D W
Published: December 2008

A general practitioner's requirements can be described in terms of three levels. These three levels are described and discussed with reference to examples from the author's own experience.
The services of a hospital medical library
Authors: Tabor R
Published: December 2008

The purpose of a hospital medical library is described under the headings of diagnostic and treatment guide, current awareness and access to published literature. The Wessex Regional Library and Information Services is described.
Departments of clinical pharmacology and therapeutics as sources of data
Authors: Herxheimer A
Published: December 2008

The functions of a clinical pharmacologist are described and some questions worth asking when prescribing drugs are listed and briefly discussed.
Representatives and advertisements as sources of information
Authors: Holland A E
Published: December 2008

The role of the representative and advertisements as information sources is discussed. Emphasis is placed on these as providing only part of the whole data package available to a doctor to enable him to make his prescribing decision.
Prevention of infection in nurseries for the newborn
Authors: Keay A J , Simpson R M
Published: December 2008

Prevention of infection in nurseries involves consideration of the design of hospitals, wards and equipment, the study of nursing and domestic procedures, the monitoring of environmental flora and the planning of antiseptic and antibiotic policies. These subjects cannot be considered in isolation from each other and are most suitably managed by a Control of Infection Committee. Ultimately the safety of infants in nurseries rests upon the degree to which each individual involved in their care pays attention to the agreed policies of general and personal hygiene.
The carpal tunnel syndrome in congestive cardiac failure
Authors: Arnold A G
Published: December 2008

A case of the carpal tunnel syndrome is described which occurred simultaneously with congestive cardiac failure. As the cardiac failure responded to treatment the carpal tunnel syndrome improved dramatically.
Naevus striatus unguis
Authors: Liddell K , Catterall M D
Published: December 2008

Three patients presented with an asymptomatic longitudinal pigmented band in a nail. A junctional melanocytic naevus in the nail matrix was suspected; this was confirmed by histological examination in each case. Differential diagnosis and management are discussed, together with a review of the literature. Local excision is considered to be the treatment of choice.