bluuebunny/crossref_metadata_2025 huggingface dataset:
Viral hepatitis in drug addicts
Authors: Sullman Susan F , Zuckerman A J
Published: December 2008

Viral hepatitis is an important and frequent complication of drug addiction. The discovery of the Australia antigen and its association with serum hepatitis has provided a number of specific serological tests which may be used for the diagnosis of at least a proportion of patients with hepatitis and also for the detection of carriers of the hepatitis virus. These tests might now be used to study in greater detail than has hitherto been possible the epidemiology of serum hepatitis among drug dependents, their contacts and the community at large.
The multiple aetiology of viral hepatitis
Authors: Zuckerman A J
Published: December 2008

Infectious hepatitis is epidemiologically and immunologically distinct from serum hepatitis. The Australia antigen is related more specifically to serum hepatitis.

The possible role of coronavirus—and paramyxovirus-like particles in the aetiology of some infections of the liver in man and in marmosets inoculated with human infectious hepatitis material is discussed and the difficulties in the interpretation of the currently available data are emphasized.

The recent studies in Melbourne of a faecal antigen found in some patients with infectious hepatitis and the discovery of an antiserum in Milan which reacted with an antigen associated with epidemic hepatitis are discussed. Mention is made of the recent isolation in Detroit-6 cells of virus-like particles from patients with infectious hepatitis.

It is concluded that viral hepatitis is an infection of multiple aetiology and that the successful cultivation in vitro of the agent or agents of hepatitis remains the outstanding and most urgent problem.
The management of acute hepatic failure
Authors: Sherlock Sheila , Parbhoo S P
Published: December 2008

Acute fulminant hepatitis leads to complex biochemical and circulatory disturbances including coma. These can be predicted to some extent by knowledge of the functions of the normal liver cells. Ineffective haemostasis, coma, hypoglycaemia, electrolyte abnormalities, hypotension and renal circulatory failure are particularly important.

Management should be governed by the abnormalities found in the individual patient. Fluid overload and sedation must be avoided. More complex methods of temporary hepatic support such as exchange transfusion or perfusion of the isolated pig’s liver should only be considered after simpler methods of correction have been attempted for a reasonable period of time and found wanting.

The prognosis of acute hepatocellular failure reaching the stage of deep coma is very poor, the mortality being about 80-90%.
Osteogenesis imperfecta in a child presenting with neurological features
Authors: Evans N A P
Published: December 2008

A case of osteogenesis imperfecta presenting with a rare neurological complication (spastic paraplegia) is presented. The aetiology of the neurological lesion is discussed.
Holt-Oram syndrome in a Maltese family
Authors: Fenech F F , Jaccarini C J , Agius P Vassallo
Published: December 2008

A Maltese family is described with the Holt-Oram syndrome.

The association of hand anomalies with congenital heart disease in a patient should be an indication to screen the other members of the family for similar defects.
The long-term treatment of hypertension with thiazide diuretics
Authors: Beevers D G , Hamilton M , Harpur J E
Published: December 2008

Two hundred and twenty-seven cases of moderate to severe hypertension were treated with thiazide diuretics alone for periods of up to 12 years. In 80% the hypertension was adequately controlled without additional antihypertensive agents.

Hypokalaemic alkalosis was common despite potassium supplements—but caused no symptoms. The incidence of diabetes and gout was low.

It is concluded that thiazide diuretics provide excellent control of hypertension with very few side effects.
Tuberculosis in Brent
Authors: McNicol M W , Mikhail J R , Sutherland I
Published: December 2008

An analysis has been made of the problem of tuberculosis in the Borough of Brent.

There have been changes in the population structure, the groups from which cases are drawn and the types of disease.

There has been an increase in the incidence of tuberculosis in immigrants of African and Asian origin, with more non-pulmonary disease.

Pulmonary disease in these groups has different clinical characteristics from those of disease in natives of the British Isles.
Mediastinoscopy: a diagnostic procedure in hilar and paratracheal lymphadenopathy
Authors: Mikhail J R , Mitchell D N
Published: December 2008

Mediastinoscopy, in the skilled hands of a thoracic surgeon, is a safe, cosmetically accepted procedure with negligible complications, less than that reported in many series of scalene node biopsies.

It has the advantage of yielding a much higher rate of diagnostic tissue, in all instances over 90%. In the cases of tuberculosis it enabled an organism to be isolated and sensitivities obtained.

It has also revealed a group of cases with findings, a further study of which may increase our understanding, assessment and management of patients presenting with hilar and/or paratracheal lymphadenopathy.
Diabetes mellitus and hypothyroidism
Authors: Bridgman J F
Published: December 2008

It would appear from the literature that hypothyroidism is rare in male diabetics. Serologically, there is an established association between autoimmune thyroiditis and diabetes mellitus. However, very little clinical evidence has been produced to confirm these findings.

A series of four male insulin-dependent diabetics with hypothyroidism, including three who had latent pernicious anaemia, were studied. Their case histories and a review of the subject are presented
Cryptococcal meningitis as a complication of systemic lupus erythematosus treated with systemic corticosteroids
Authors: Collins J V , Tong D , Bucknall R G , Warin A P
Published: December 2008

Cryptococcosis, a disease of world-wide distribution, is uncommon in the British Isles where it usually presents as meningitis affecting patients with malignant disease of the reticulo-endothelial system, diabetes mellitus or those receiving systemic treatment with corticosteroids. The clinical features and physical signs of the disease are often non-specific and resemble those of tuberculous meningitis. The diagnosis is made upon recognizing the encapsulated Cryptococcus neoformans on Indian Ink preparations of the cerebrospinal fluid, or by demonstrating precipitating antibodies to the organism in the patient's serum. The treatment is by intravenous administration of amphotericin B for a period of 6–12 weeks, supplemented in severe or relapsing cases by intrathecal therapy; alternatively, 5-fluorocytosine may be given by mouth. A case is reported of cryptococcal meningitis occurring in a 46-year-old woman with systemic lupus erythematosus treated with methylprednisolone. Treatment with amphotericin B was successful in suppressing the infection, but was accompanied by side-effects and some temporary impairment of renal function.
Mechanisms of renal tubular defects in old age
Authors: Dontas A S , Marketos S G , Papanayiotou P
Published: December 2008

The mechanisms of renal tubular dysfunction in old age have been examined in twenty-eight clinically healthy elderly subjects without infection, and in fourteen subjects of similar age with laboratory evidence of intrarenal infection. The data were compared with those from thirteen clinically healthy young subjects. Studied were: proximal tubular (TmPAH) and distal tubular (CH2O) activity, minimal and maximal osmolal U/P ratios, maximal osmolal excretion in hydropenia, and GFR levels under standard hydration and under water-loading.

The reduction of GFR in old age is evident particularly in men under conditions of standard hydration: it is accentuated in the presence of renal infection. Proximal tubular activity is also significantly lower in elderly men, especially if they have chronic bacteriuria. The reduction is closely related to GFR levels, with identical TmPAH:Cin ratios in all groups. This supports the intact nephron hypothesis for this part of the nephron. Distal tubular activity is depressed in old age in both sexes proportionately more than proximal tubular activity or the GFR. The lower CH2O: GFR ratios imply a selective distal tubular damage.

Maximal osmolal U/P ratios in hydropenia are significantly higher in the young (mean 367) than in either the elderly non-infected (mean 279) or the elderly infected subjects (mean 212). Conversely, minimal U/P ratios in water-loading are lower in the young (mean 0.247) than in either elderly group (means 0.418 and 0.668). Osmolal excretion in hydropenia is not different between the groups, but urine flows in water-loading clearly separate them.

The data indicate that simple functions of the distal-collecting tubule (e.g. the CH2O), are less affected in old age than are functions involving several medullary structures (as is the maximal Uosm or U/P ratio). They suggest that the main impairment of the distal tubular cell involves the failure to achieve a proper osmotic gradient between tubular fluid and blood, rather than an inability to excrete or re-absorb an adequate amount of solute. Finally, it appears that renal infection aggravates the larger glomerular and proximal tubular deficits observed in non-infected men: it depresses distal tubular function equally in both sexes.
Results of patellectomy for osteoarthritis
Authors: Dinham J M , French P R
Published: December 2008

Seventy-three knees which had undergone patellectomy for patello-femoral osteoarthritis are reviewed.

A possible mechanism of involvement of the tibiofemoral joint is described.

Patellectomy, when the disease is confined to the patello-femoral articulation, appears to be beneficial over a 5-year period. When arthritic changes are present in the tibio-femoral joint, patellectomy may be beneficial in about half the patients.
Pseudohypoparathyroidism with paradoxical increase in hypocalcaemic seizures due to long-term anticonvulsant therapy
Authors: Glynne Alan , Hunter Iain P , Thomson John A
Published: December 2008

A case of pseudohypoparathyroidism is described. Unusual features included the apparent absence of a familial history and the long delay in clinical diagnosis. Dental evidence is presented which dates the metabolic abnormality back to at least the age of 2, yet symptoms did not appear until the age of 12 and the correct diagnosis was not made until she was 32. The role of long-term anticonvulsant therapy in the paradoxical exacerbation of the patient's hypocalcaemic seizures is discussed.
Peripheral neuropathy with ethambutol
Authors: Tugwell P , James S L
Published: December 2008

Three cases are described in which peripheral neuropathy occurred while the patients were taking ethambutol. The neuropathy regressed when the drug was stopped.
Some chemical indices of diabetic vascular disease
Authors: Wardle E N , Piercy D A , Anderson J
Published: December 2008

Some chemical indices which could be related to diabetic complications have been assessed in 105 diabetics.

In juvenile (insulin-dependent) diabetics with retinopathy, cardiovascular disease or nephropathy, levels of fibrinogen, fibrin monomer, beta-lipoprotein, cholesterol and alpha-2-macroglobulin were raised. Only in part is the explanation due to a rise of fibrinogen and cholesterol with age. Among twenty-six patients with a plasma fibrinogen over 400 mg/100 ml, eleven sustained a major cardiovascular catastrophe within the next 2 years. Alpha-1-acid-glycoprotein was raised in these eleven and beta-2-glycoprotein generally in juveniles with cardiovascular disease. Triglycerides were elevated in all groups, but notably in patients with Grade I retinopathy with venous dilation. There was a suggestion that triglycerides were related inversely to dietary carbohydrate in mature onset diabetics, and serum cholesterol in juveniles was related to insulin dosage. The part of lipids in vascular disease is then discussed. An interesting positive correlation was found between fibrin monomer, itself an indication of in vivo thrombin formation, and beta-lipoprotein.

Although alpha-2-macroglobulin was elevated in juveniles, especially with complications, this did not apply to maturity onset cases and therefore no direct relation to diabetic vascular disease can be suggested. Moreover, alpha-2-macroglobulin levels were normal in acromegaly.
Foetus acardius amorphus
Authors: Alderman Brian
Published: December 2008

A case of acardius amorphus is reported. The rarity of foetal monsters without a functioning heart is emphasized and the method of classification reviewed. The theories of teratogenesis are discussed. Evidence is presented in support of the theory that there is a primary failure of the organ to develop. The possibility of anoxia and nutritional deficiency of the foetus being solely responsible for the malformation seems unlikely.
Steatorrhoea and jejunal reticulum cell sarcoma occurring in a patient on long-term colchicine therapy for gout
Authors: Boucher B J , Wright J T
Published: December 2008

A second case is described where steatorrhoea developed following long-term colchicine therapy for gout; the relationship of therapy to the development of a reticulum cell sarcoma of the jejunum is discussed.
A tale of two cities: a comparison of sarcoidosis in London and Paris
Authors: James D Geraint , Turiaf J , Walker A N , Battesti J P
Published: December 2008

Two large series of patients with sarcoidosis in London and Paris have been analysed and compared for differences in ethnic background, clinical features, mode of onset and duration, chest radiographic resolution, laboratory investigation and treatment.

It is found that in both capitals, sarcoidosis is a multisystem disorder. Most organ-systems of the body are invaded, emphasizing the fact that sarcoidosis transcends boundaries of various specialties, making it a disorder of general medical interest.

The diagnosis was confirmed by various histological techniques and the Kveim-Siltzbach test was found to be positive in three-quarters of patients in both series.

Depression of delayed type hypersensitivity, abnormal serum globulins and hypercalcaemia were observed in a significant proportion of both series.

Corticosteroids were administered to one-third of the London and to two-thirds of the Paris patients. The patient has the same chance of survival whether he lives in London or Paris, for the overall mortality is about 5% in both countries.
Inactivated vaccines. 2. Laboratory indices of protectionPresented by the senior author before the symposium on Influenza Vaccines, London, 27 April 1972.
Authors: Dowdle W R , Coleman M T , Mostow S R , Kaye H S , Schoenbaum S C
Published: December 2008

The data from our 1968–69 influenza vaccine field trials are anlaysed and pre-challenge haemagglutinin and neuraminidase serum antibodies are evaluated as indices of protection. Prevention of flu-like disease, fever, confinement to bed, and/or seroconversion to Hong Kong was significantly related to post-vaccine A/Hong Kong/68(H3N2) haemagglutination-inhibition (HI) titres. Prevention of disease was also related, although not significantly statistically in every category, to pre-challenge A/Hong Kong/68 neuraminidase inhibition (NI) titres. The trend was the same regardless of whether the origin of the NI antibody was through A/Aichi/68 or A/Japan/62 vaccines or through pre-Hong Kong influenza infections. In summarizing the data using fever as an index of disease, the attack rate (AR) among volunteers without Hong Kong NI or HI antibody was 45%. Presence of NI antibody, in the absence of HI antibody, significantly reduced the AR to 24%. Those with both NI and HI titres experienced a still lower AR of 14%. Those with HI and NI titres both > 1: 160 ran little risk of disease, with an AR of 7%.
Age-related response to 1000 CCA unit zonally purified, inactivated influenza vaccines in volunteers in the U.S.A.
Authors: Marine William M , Thomas James E
Published: December 2008

Response to 1000 CCA unit Aichi/68 and Japan/57 influenza vaccines was studied in 687 volunteers from ages 6–101 in the summer of 1971. The vaccines, prepared by zonal ultracentrifugation, were well tolerated in all age-groups. Antibody responses were comparable with each vaccine and were strongly influenced by age of the volunteer. Persons born since 1940 (age 31 and under) had a much more impressive response as determined by both overall geometric mean titre rise and% with ≥ four-fold increase in titre than persons born before 1940. The most reasonable explanation for this phenomenon seems to be the greater prior exposure of the younger age-groups to the strains in the vaccines. It is concluded that more attention needs to be given in the future to assessing vaccine potency in the age-groups for which the maximum protection is desired, namely, the elderly.
Nasal and circulating antibody responses to influenza vaccination and their importance in resistance to infection
Authors: Tyrrell D A J , Buckland R A , Schild G C , Freestone D S , Chinn S , Slepushkin A N
Published: December 2008

Small groups of volunteers were inoculated intranasally with live-attenuated, and parenterally with detergent-split-saline or with whole-virus-oil-adjuvant influenza A2/HK (H3N2) vaccines after the prevalence of Hong Kong strains. Antibody titres in nasal secretions and serum were measured by HI, antineuraminidase and neutralization tests. The oil adjuvant vaccine produced large rises in antibodies and the other two vaccines produced small rises. The volunteers given oil adjuvant and live vaccine were both well protected against challenge with a partly attenuated strain. Statistical analysis showed that resistance to infection was predicted best by high titres of antibody in the serum, but the presence of antibody did not seem to explain completely resistance to infection.
The effect of a low-calorie diet with and without fenfluramine on the glucose tolerance and insulin secretion of obese maturity-onset diabetics
Authors: Dykes J Ranald W
Published: December 2008

Glucose tolerance and insulin secretion have been measured in twenty-three obese maturity-onset diabetics (twelve high-insulin secretors and eleven lowor normal-insulin secretors) on first presentation and after 10 weeks on a low-calorie diet. There was a significant improvement in glucose tolerance alone, when the results were compared with those from diabetics not on any form of treatment.

Thereafter nine of these subjects (five high-insulin secretors and four low- or normal-insulin secretors) continued on the dietary therapy alone, and eleven of the remaining fourteen subjects (six high-insulin secretors and five low- or normal-insulin secretors) continued on the low-calorie diet with the addition of fenfluramine, and their glucose tolerance and insulin secretion were measured again after a further 10 weeks. The remaining three subjects were no longer studied. The nine subjects continuing on the diet alone showed maintenance of the improvement in glucose tolerance achieved during the first 10-week period with no significant change in insulin secretion. The eleven subjects placed on fenfluramine in addition to the diet also showed maintenance of the improvement in glucose tolerance achieved during the first 10-week period with a significant decrease in insulin secretion in the six high-insulin secreting subjects and no significant change in insulin secretion in the five lowor normal-secretors.
Pleural effusions and yellow nails of late onset
Authors: Eastwood H D , Williams T J
Published: December 2008

Recurrent pleural effusions have recently been described associated with a generalized deficiency of lymphatic drainage. A case is reported which is of interest as, though evidence of such a deficiency had been present as lymphoedema of the legs since childhood, further manifestations of this in the form of discoloured nails and recurrent pleural effusions developed in the eight and ninth decades.
The role of lung imaging in pulmonary embolism
Authors: Mishkin Fred S , Johnson Philip M
Published: December 2008

The advantages of lung scanning in suspected pulmonary embolism are its diagnostic sensitivity, simplicity and safety. The ability to delineate regional pulmonary ischaemia, to quantitate its extent and to follow its response to therapy provides valuable clinical data available by no other simple means. The negative scan effectively excludes pulmonary embolism but, although certain of its features favour the diagnosis of embolism, the positive scan inherently lacks specificity and requires angiographic confirmation when embolectomy, caval plication or infusion of a thrombolytic agent are contemplated. The addition of simple ventilation imaging techniques with radioxenon overcomes this limitation by providing accurate analog estimation or digital quantitation of regional ventilation: perfusion (V/Q) ratios fundamental to understanding the pathophysiologic consequences of embolism and other diseases of the lung.
Ornithosis in Somerset. Experience in the South Somerset Clinical Area 1964–71
Authors: Anderson J P
Published: December 2008

During an 8-year period, seventy patients were found, by complement fixation testing, to have had ornithosis. A clinical analysis was made of forty-seven who fulfilled strict diagnostic criteria; thirty-three had been referred to a chest clinic, fourteen had been hospitalized. A non-specific, febrile, myalgic illness with respiratory symptoms was the usual clinical syndrome; cough was a prominent, often dramatic, symptom. Pulmonary crepitations, variable radiographic changes, and a normal white blood cell count were found to be useful diagnostic features. Ornithosis sometimes masqueraded as major chest disease, and could be debilitating. Careful retrospective interrogation revealed significant bird contacts in the majority of patients. Treatment with a tetracycline was of possible clinical benefit.
Marburg virus disease
Authors: Martini G A
Published: December 2008

In the late summer of 1967 an epidemic in thirty-one patients in Germany and Yugoslavia of a disease transmitted from African green monkeys occurred; seven patients died. The incubation period was from 4 to 7 days. The main clinical features were headache, high fever, diarrhoea, a very characteristic rash, severe bleeding tendency and involvement of the central nervous system. Nearly all organs were involved and showed severe cell necroses. The aetiological agent was identified as an RNS-virus and was named Marburg virus. It was detected in the blood, urine, throat-washing and seminal fluid.
Pseudo-pseudo-hypoparathyroidism with coarctation of the aorta—a clinical syndrome?
Authors: de Swiet J
Published: December 2008

Two cases of pseudo-pseudo-hypoparathyroidism are described, associated with coarctation of the aorta, suggesting a further common clinical link (besides those already recognized) between the former condition and Turner's syndrome. The need for a change of nomenclature of pseudo-pseudo-hypoparathyroidism is emphasized.
Oral antibiotic cure of staphylococcal endocarditis
Authors: Burman N D , Joffe H S , Watson C
Published: December 2008

There are as yet few clinical reports of successful treatment of bacterial endocarditis with oral antibiotics, or of the use of the rifamycins in non-tuberculous infections. A case of refractory staphylococcal endocarditis successfully treated with oral rifampicin and erythromycin is presented. The availability of effective oral antibiotic therapy avoids the serious difficulties of long term parenteral antibiotics and offers a hopeful alternative to emergency cardiac surgery in this condition.
Treatment of active chronic hepatitis with cyclophosphamide
Authors: Naccarato R , Chiaramonte M , Farini R , Fagiolo U , Sturniolo G C
Published: December 2008

Twenty patients with active chronic hepatitis, classified on the basis of the treatment into three groups, have been studied: (1) patients treated with cyclophosphamide (10 patients); (2) patients treated with cyclophosphamide after cycles of corticosteroid therapy (four patients); (3) patients treated with corticosteroid (six patients).

In all patients we observed clinical, biochemical and immunological changes during and after treatment.

Hepatic needle-biopsy was performed in all patients before treatment. The histological picture was rechecked after the first cycle of therapy in twelve patients.

The results obtained in the three groups of patients have been statistically compared.

Cyclophosphamide treatment produces an improvement of general conditions and a persistent normalization of several biochemical and immunological data, especially in those patients in which active chronic hepatitis was not in an advanced stage (type A aggressive form). The histological picture showed no changes after treatment.
Survival rate at middle age in developing and western populations
Authors: Walker Alexander R P
Published: December 2008

Whereas expectation of life at birth invariably is greater in more privileged populations, the respective survival patterns at middle age can be entirely different. Comparisons have been made between South African and other populations, using, as a survival index, the number who are 70 years or more at present, as a percentage of the number who were 50 years or more 19 years earlier (data for the desired 20-year period were not available for all populations). Briefly (1) South African Negroes had the highest index; Indians both in India and South Africa the lowest; Caucasian populations in South Africa, United States, and England and Wales, were intermediate. (2) Indices for females were higher than for males; the disparity was least in Indians, but greatest for the population of England and Wales. Evidently, with progressive sophistication of diet and manner of life, the concomitant change from infections to degenerative diseases, as main causes of death at middle age and beyond, reduces rather than increases chances of survival.
How doctors prescribe and why
Authors: Teeling-Smith G
Published: December 2008

Branded prescription medicines account for 95% of the total cost of the NHS pharmaceutical service, and 74% of all prescriptions written by general practitioners employ the brand name. This predominance of branded preparations reflects the fact that 96% of the leading medicines prescribed in 1969 had been first introduced since 1949. These are the products of modern pharmaceutical research, typically introduced under their brand name.

Potential savings, if generic names were used instead of brand names in prescribing, are very small because it is only in exceptional cases that cheaper alternatives exist with the same active ingredients as the original branded preparation.

The paper suggests that since general practitioners appear so overwhelmingly to favour the use of brand names it would be logical to introduce their use into medical teaching.
Europe
Authors: Grainger H S
Published: December 2008

At the present time, pharmacopoeias concentrate on defining the active principle of a product, limits of impurities and certain in vitro tests such as disintegration and dissolution rate which have been thought, incorrectly in many instances, to predict absorption characteristics.

In future, tests must be developed which will more adequately predict bio-availability and these, with information comparing the blood levels and clinical effects of different preparations of drugs, must be available to the prescriber in a pharmacopoeia or other officially recognized compendium.
The association between webs, iron and post-cricoid carcinoma
Authors: Chisholm Morag
Published: December 2008

The association of iron deficiency anaemia, post-cricoid webs and carcinoma is controversial. The main findings in a recent study which re-examined this problem are presented here. It was shown that the majority of patients with a post-cricoid web have evidence of iron deficiency but that only about 10% of patients with iron deficiency develop post-cricoid webs. Factors which might be important in the pathogenesis of a post-cricoid web have been looked for and a few significant points noted. The main findings were an increased frequency of angular stomatitis and edentia, thyroid disease and thyroid cytoplasmic antibodies in patients with webs compared with patients with iron deficiency anaemia without a web.

Follow-up studies in patients with a post-cricoid web or Paterson-Kelly syndrome show an increased frequency of post-cricoid carcinoma ranging from 4 to 16% in different series and the association is even more striking in patients presenting with post-cricoid carcinoma. It is concluded that the available evidence confirms the association between iron deficiency, postcricoid webs and carcinoma but the mechanism of the production of these changes is not yet understood.
Transient erythroid hypoplasia in a patient on long-term co-trimoxazole therapy
Authors: Stephens M Elizabeth M
Published: December 2008

The occurrence of isolated erythroid hypoplasia in a patient on long-term treatment with co-trimoxazole is described. It is suggested that this haematological complication, which has not been previously reported, was due to hypersensitivity to the sulphonamide component.
Female genital self-mutilation as a cause of vaginal bleeding
Authors: Simpson M A , Anstee B H
Published: December 2008

While self-mutilation in the form of wrist and arm cutting is relatively common and genital self-mutilation in men is well recognized, female genital self-mutilation seems to be strikingly rare. With the exception of injuries secondary to frank self-induced abortion or the insertions of foreign bodies in children, only three cases of female genital self-mutilation have been reported in the literature so far. It is suggested that the phenomenon may not be as rare as hitherto supposed and therefore a further case is reported.
Viral hepatitis and hepatitis B antigen: recent advances
Authors: Krugman Saul
Published: December 2008

Recent advances in hepatitis research have shed new light on the etiology, pathogenesis, epidemiology and prevention of type B hepatitis infection. The so-called ‘Dane’ particle is probably the complete hepatitis B virion; its outer coat is the hepatitis B (Australia) antigen (HB Ag) and its inner core is an immunologically distinct particle. Subtypes of HB Ag (a, d, y, w and r) are useful indices for epidemiological surveys. Concepts of epidemiology have changed: type B hepatitis is transmissible by contact as well as by inoculation. The presence of HB Ag in blood is indicative of the presence of hepatitis B virus. Tests to detect antigen and use of voluntary blood donors have played a major role in the decreased incidence of post transfusion hepatitis. A special hepatitis B gammaglobulin preparation and a heat-inactivated hepatitis B vaccine have proved to be effective in preliminary studies.
The role of immunological mechanisms in acute and chronic hepatitis
Authors: Eddleston A L W F
Published: December 2008

Studies of asymptomatic carriers of hepatitis B antigen (HB Ag) have suggested that the hepatitis B virus may not be directly damaging to liver cells and it is possible that the hepatocellular necrosis which accompanies acute hepatitis may be induced by immunological reactions directed at viral antigenic determinants on the surface of infected cells.

Immunological reactions may also be implicated in the pathogenesis of active chronic hepatitis. Although antibodies which are commonly present in the serum are probably not of primary importance in the immunopathology, recent studies have demonstrated liver-specific immune responses, both humoral and cellular, which may be more directly related to the pathogenesis.
Treatment of chronic active hepatitis in children
Authors: Dubois Reuben S , Silverman Arnold
Published: December 2008

Thirty-eight children with chronic active hepatitis are reported. Their mode of presentation was usually indistinguishable from acute viral hepatitis (63%). Extra hepatic manifestations were more common in those patients with an insidious onset. The twenty-eight patients tested for hepatitis B antigen (HB Ag) were all negative and SGOT values were higher (mean 1000 i.u./l) than those reported in adult patients with chronic active hepatitis. Thirty-three patients had marked elevation of serum gammaglobulin (mean 3·78 g/100 ml) and 34% had positive LE cells. All patients had histologic features of ‘aggressive’ hepatitis; in addition five biopsies also showed areas of submassive hepatic necrosis. The initial response to corticosteroid was excellent in all but three patients. To date drug therapy has been suspended in fifteen patients for periods of 3 months to 4 years and 7 months. There have been eight deaths. Three with hepatic insufficiency and two with sepsis. Three others have subsequently died following orthotopic liver transplantation.
Controlled trials of immunosuppressive therapy in hepatitis
Authors: Stern R B , Williams Roger
Published: December 2008

Three types of hepatitis are seen in children—acute viral hepatitis, active chronic hepatitis and the neonatal hepatitis syndrome. Few adequate controlled clinical trials of immunosuppressive therapy have been performed in these conditions, and none specifically in children.

Many trials in the 1950s using corticosteroids were performed in acute viral hepatitis. Some showed that steroids were superior to controls and some showed no difference. Later trials confirmed that steroids were of no benefit in uncomplicated viral hepatitis, and further trials are now unjustifiable.

Active chronic hepatitis is seen in all age groups, and there is little clear-cut evidence that the disease differs significantly in children from adults. Three well controlled clinical trials using immunosuppressive agents have been performed in this condition, but all were predominantly in adults. The conclusions were that steroids are the treatment of choice, although azathioprine may have a steroid-sparing effect.

No prospective controlled trials of immunosuppressives have been carried out in the neonatal hepatitis syndrome, and in view of the variable prognosis there is an urgent need for one to be carried out. Large numbers, and a long follow-up period would be necessary and the trial need not be performed doubleblind.
Verapamil and the myocardium
Authors: Nayler Winifred G , Krikler Dennis
Published: December 2008

Although many of the drugs which recently have been developed for use in relieving angina pectoris display β-adrenoceptor blocking activity this property cannot be essential, because verapamil relieves angina pectoris without blocking the cardiac β-adrenoceptors. Like propranolol, verapamil slows the heart and reduces both the peak tension developed during systole and the rate at which that tension is developed. Verapamil further resembles propranolol in that it improves cardiac efficiency, reduces the oxygen requirement of the heart and abolishes certain arrhythmias. Verapamil differs from propranolol, however, in that it does not antagonize the cardiac β-adrenoceptors and it dilates the coronary vessels. Verapamil probably owes its activity to its ability to interfere with the inwards displacement of calcium ions across cardiac cell membranes.
Diabetes insipidus and marked elevation of foetal haemoglobin in a case of acute leukaemia
Authors: Cumming W J K , Spiers A S D
Published: December 2008

A case of acute myelomonocytic leukaemia is described in which diabetes insipidus was the presenting symptom.
Prevalence and site of bacteriuria in diabetes mellitus
Authors: Ooi Boon Seng , Chen Beatrice T M , Yu Moses
Published: December 2008

Twenty-four of 152 female diabetic patients (15·8%) were found to have significant bacteriuria as compared to a prevalence rate of only 4·6% of 152 matched non-diabetic controls. The difference in prevalence rates is statistically significant. However, if the prevalence rates are analysed according to age, bacteriuria was significantly more common only in diabetic females above the age of 50. Localization of site of infection was performed in all diabetic female subjects with bacteriuria. The kidney was affected in 62·5% of patients. The pathogenetic considerations relating to these results are discussed. There was no difference in prevalence rate of bacteriuria between male diabetics and their controls.
Food contaminants
Authors: Kazantzis G
Published: December 2008

With the increasing use of a large variety of chemicals, opportunities for contamination of food are becoming greater. Food may be involved following some accidental occurrence or from more general environmental contamination. Three examples are given: an outbreak of paralysis in Morocco involved 10,000 people who had ingested food adulterated with triorthocresyl phosphate; an epidemic of jaundice in London followed the contamination of flour with an epoxy resin hardener; organic mercury poisoning in an Arab country involved more than 6000 people who had eaten bread made from grain treated with a methyl mercury fungicide. The hazard which may arise from heavy metal accumulation in the body is discussed.
Blood lipids and the treatment of essential hypertension with methyldopa and bendrofluazide
Authors: Libman L J , Dormandy T L , Arrowsmith D E , Heal Joanna , Hoffbrand B I
Published: December 2008

The blood lipids of eight patients with previously untreated essential hypertension have been studied before and after treatment with methyldopa and bendrofluazide. No significant change was found in any of the measurements over a mean treatment period of 5·25 months. These results are believed to provide evidence that hypotensive therapy does not predispose to the development of ischaemic heart disease.
Incidence of Meckel’s diverticulum in 100 cadavers
Authors: Rojhan M S , Hejazi R
Published: December 2008

The literature concerning the embryology, histology, clinical significance and preoperative diagnosis of Meckel’s diverticulum has been reviewed.

Meckel’s diverticulum was found in about 6% of subjects from the Tehran region, suggesting that it occurs more frequently in Iran than previously supposed.
A case of primary cerebral venous thrombosis
Authors: Brookfield D S K
Published: December 2008

A case of primary cerebral thrombophlebitis is described in a young man, who had a thrombotic diathesis. The patient initially presented with a right phlegmasia alba dolens which was treated with anticoagulants, surgery and thrombolytic therapy. Over 2 years later he developed a further phlegmasia and what was clinically thought to be a meningitis. Despite anti-coagulation he died from a progressive cerebral venous thrombosis.
Ectopic thymus of the neck—report of three examples in children
Authors: Lewis C T
Published: December 2008

Three children with ectopic thymic tumours of the neck are described. One solid mass was situated in the midline whilst two were unilateral and cystic. The difficulties of diagnosis and surgical removal are stressed and the question of interference to immunological competence discussed.
Eosinophilic granuloma of the ileum
Authors: Myers A , Humphreys Daphne M , Williamson R C N
Published: December 2008

A case of eosinophilic granuloma of the ileum is described in association with a high (50%) eosinophil count. A review of published suggested classifications, aetiology and therapy is made.
Skin as a microhabitat
Authors: Noble W C
Published: December 2008

Only recently has it become appreciated how complex an ecological medium is formed by the human skin. There are many chemical substances, both inorganic and organic, which contribute to the maintenance of the skin population. Nevertheless, it seems probable that some microbial growth factors are contributed by organisms resident on the skin.
Microbial ecology of the female lower genital tract during pregnancy
Authors: de Louvois John , Hurley Rosalinde , Stanley Valerie C , Jones J B , Foulkes J E B
Published: December 2008

The posterior fornices of the vagina of 280 unselected pregnant women were sampled, using a sponge swab, squeezed out into Stuart’s Transport Medium. Other specimens were also taken. Eleven primary media were inoculated, wet swabs were examined, and Gramstained smears were also made. Nineteen groups or species of microbes were identified.

Nearly 80% of women harbour pathogenic, or potentially pathogenic microbes; 52% harbour streptococci of various sorts. The incidence of the various groups, and species of microbes is tabulated. There is a statistically significant correlation between the presence of polymorphonuclear leucocytes in excess of one per high power field, and the presence of lesions of the cervix.
The effects of adrenergic β-blockade with oxprenolol on peripheral metabolism
Authors: Asmal A C , Coleman A J , Leary W P
Published: December 2008

Peripheral metabolism was studied with the forearm technique in six fasting normal subjects before and after oxprenolol administration. With the forearm technique the product of blood flow and arteriovenous differences is a measure of substrate uptake or release, and, therefore, an index of metabolism. Blood flow was measured with venous occlusion plethysmography, and arterial and venous samples obtained through indwelling catheters in the radial artery and deep forearm vein.

Oxprenolol administration influenced both peripheral flow and the basal pattern of substrate exchange. Before oxprenolol blockade a net uptake of glucose, triglycerides, and FFA, and a net release of glycerol were recorded across the forearm. After oxprenolol blockade there was a marked reduction in triglyceride uptake, with augmentation of glucose uptake and inhibition of lipolysis.
Hodgkin’s disease of the duodenum presenting with haemorrhage and perforation
Authors: Bardhan K D , McArthur Peter , Rigby Christopher
Published: December 2008

A case of Hodgkin’s lymphoma confined to the duodenum, draining lymph nodes and spleen, presenting with haematemesis and perforation, thus mimicking a peptic ulcer, is recorded. Such a case is not known to have been previously reported.
Self-induced colitis
Authors: Byrne Jane S , Carney M W P , Harry D S , Lee F I
Published: December 2008

The case is reported of a young ex-nurse with severe inflammation in the distal colon, extending 15 cm proximally from the anus, due to the self-instillation of a noxious substance, namely, caustic soda. She escaped detection over a period of months. The result was extensive inflammatory change in the terminal 15 cm of the large bowel, with gross macroscopic, histological and radiological abnormalities.
An unusual case of spontaneous bacterial myositis
Authors: Williams R H P , Thomas P
Published: December 2008

A further report of spontaneous bacterial myositis occurring in the British Isles is recorded. The case is unusual because both calf muscle compartments were simultaneously affected, and unique in that surgical decompression was required to prevent impending limb ischaemia.
Pathological recognition of cardiomyopathy
Authors: Olsen E G J
Published: December 2008

Using the classification employed in the preceding paper, for each type of cardiomyopathy a pathological counterpart exists. This communication summarizes the salient features which permit recognition of the various types of cardiomyopathy. They have been described by many workers in recent years and have been reviewed by this author in 1972 (a, b) and 1973.
Results of endomyocardial biopsy—histological, histochemical and ultrastructural analysis
Authors: Olsen E G J
Published: December 2008

Although this technique of investigation has been practised for many years in Japan and reported by Konno, Sekiguchi and Sakakibara in 1971, it has only recently become more widely used in Europe. So far, biopsy material from fifty-six patients*, thirty-nine of whom were suspected of suffering from a type of cardiomyopathy, have been examined. This paper concentrates on the diagnostic value which can be derived from the material obtained by Konno’s bioptome (Sakakibara and Konno, 1962) or by the King’s College Hospital instrument (Richardson, 1973).
Distribution of digoxin in the human heart
Authors: Coltart D John , Güllner Hans George , Billingham Margaret , Goldman Robert H , Stinson Edward B , Kalman Sumner M , Harrison Donald C
Published: December 2008

Data defining the intramyocardial distribution of digoxin and its relationship to serum levels are lacking primarily owing to the limitation of an adequate supply of myocardial tissue for study. By using the recipient heart removed at the time of cardiac transplantation a supply of myocardial tissue is realized for more definitive studies of the distribution of digoxin, as reported in this study.
Granulomas of the liver
Authors: Neville E , Piyasena K H G , James D Geraint
Published: December 2008

The authors personally studied 138 patients with liver granulomas: seventy-five (54%) had sarcoidosis, twenty-six (19%) had primary biliary cirrhosis, twenty-three (17%) had miscellaneous recognizable disorders and fourteen (10%) were undiagnosed. The modes of presentation, the clinical, biochemical and radiological features are compared, and the course of each disease is followed. The undiagnosed group were frequently middle-aged men presenting with abdominal pain, fever and hepato-splenomegaly. The unsatisfactory term granulomatous hepatitis, if used, should be reserved for this undiagnosed residue until follow-up reveals a more definite aetiology.
Smoking and optic neuritis
Authors: Perkin G D , Bowden P , Rose F Clifford
Published: December 2008

The effect of smoking on the recovery of visual function after an attack of optic neuritis has been assessed in 125 patients. Heavy smokers were found to have a higher incidence of red/green colour vision defects than non-smokers. The possible implications of this finding are discussed.

One patient is described in whom smoking caused transient blurring of vision. The effects of nicotine on the central nervous system are reviewed, and a pathophysiological mechanism suggested for this phenomenon.
Watery diarrhoea and hypokalaemia associated with a phaeochromocytoma
Authors: Loehry C A , Kingham J G C , Whorwell P J
Published: December 2008

The syndrome of water diarrhoea, hypokalaemia and achlorhydria (WDHA) is well described in association with a non-beta islet cell tumour of the pancreas. The following case report is of a 28-year-old woman with a WDHA syndrome that was cured by the removal of a phaeochromocytoma.
Renal retention of sodium in cirrhosis and fulminant hepatic failure
Authors: Wilkinson S P , Alam A , Moodie Helen , Williams Roger
Published: December 2008

Abnormal renal retention of sodium is a characteristic finding in both cirrhosis and fulminant hepatic failure. In cirrhosis the pathogenesis varies according to the level of renal perfusion. When this is normal, hyperaldosteronism is probably the most important factor and this results from an increased release of renin by the kidney. The stimulus to the latter may be a shunting of blood from the outer cortical to juxtamedullary nephrons, although there is no direct relationship between the changes in intrarenal blood flow distribution and sodium excretion. The patients with hyperaldosteronism fail to escape from its sodium retaining effects because of impaired production of natriuretic hormone, which in turn is the result of a failure to expand the ‘effective’ extracellular fluid volume, because of ascites formation.

In fulminant hepatic failure the site in the nephron of abnormal sodium retention appears to be predominantly the proximal tubule, but its cause is obscure.
Endemic cretinism—a continuous personal educational experience during 10 years
Authors: Querido A
Published: December 2008

The processes involved in the progress of scientific knowledge have fascinated philosophers, scientific workers and non-scientists. Kuhn (1970), in his interesting essay on the structure of scientific revolutions, sees the road which the growth of scientific knowledge follows, not marked by discoveries but by what he names paradigms, ‘theories that gain their status because they are more successful than their competitors in solving a few problems …’ which are recognized as acute. Examples of paradigms in biology are, e.g. Berthold’s conceptualization of endocrinology in 1849; Mendel’s theory of inheritance; Medawar’s concept of immunological tolerance, etc.