bluuebunny/crossref_metadata_2025 huggingface dataset:
Relapse of ulcerative proctocolitis during treatment with non-steroidal anti-inflammatory drugs
Authors: Rampton D S , Sladen G E
Published: December 2008

In four patients with inactive ulcerative proctocolitis, oral administration of non-steroidal anti-inflammatory drugs appeared to precipitate relapse. These observations suggest that inhibitors of prostaglandin synthesis should be used with care in patients with this disease, and are consistent with the hypothesis that prostaglandins may have a protective role in the lower as well as the upper gastrointestinal tract.
Sotalol-induced torsade de pointes
Authors: Kontopoulos A , Manoudis F , Filindris A , Metaxas P
Published: December 2008

The authors report a case of torsade de pointes atypical ventricular tachycardia in a patient with chronic renal failure and hypertension treated with sotalol hydrochloride which they believe induced the arrhythmia.
Orogenital ulcers, SLE and hydralazine
Authors: Neville E , Graham P Y , Brewis R A L
Published: December 2008

The case is reported of a man developing drug-induced systemic lupus erythematosus while taking hydralazine. The illness was characterized by arthritis and a purpuric rash particularly in the light-sensitive areas as well as orogenital and cutaneous ulceration. Anti-nuclear antibody and DNA binding were positive. All clinical manifestations disappeared on withdrawal of hydralazine.
Hepatic artery aneurysm following cholecystectomy
Authors: Thomas W E G , May R E
Published: December 2008

A rare case is reported of an hepatic artery aneurysm developing 5 months after cholecystectomy. This presented as massive haemobilia as a result of the aneurysm communicating with the cystic duct stump. The diagnosis was delayed owing to the complicating features of Waldenström’s macroglobulinaemia and jejunal diverticulosis.
Malignant lymphomas: results and observations from St George’s Hospital
Authors: Lee R , Tungekar M F , Harmer C L , Rose M S
Published: December 2008

With both Hodgkin’s and non-Hodgkin’s lymphoma, the results documented compared well with reference series. Hence the advantages of a modest clinic need not be at the cost of recovery or of survival.

A major factor attenuating the scale of therapy in Hodgkin’s disease is the risk of inducing second malignancies. Four such complications have been observed amongst 27 patients with Hodgkin’s disease.

Amongst the patients with non-Hodgkin’s lymphoma better results were noted than the designation ‘poor prognosis histology’ had led the authors to expect. These findings suggest that the concept of histologically based prognosis may be over-subscribed and that contemporary therapeutic strategies can be extremely effective in this group.
Acute transverse myelopathy complicating tetanus
Authors: Bahemuka M
Published: December 2008

A 12-year-old boy presented with typical features of short incubation tetanus. Spastic paraparesis with a mid-thoracic sensory level was present from the time of the initial examination. X-rays of the spine and lumbar myelogram were normal. The paraparesis improved rapidly and within a month the patient was free of neurological deficit. The case is possibly a rare example of tetanus involving the central nervous system other than the anterior horn cells.
Umbilical haemorrhage—an unusual complication of cirrhosis
Authors: Douglas J G
Published: December 2008

A 59-year-old woman known to have micronodular cirrhosis presented with haemorrhage from the umbilicus. She eventually required exomphalectomy at which a huge patent umbilical vein was found and ligated. Selective coeliac and superior mesenteric angiography with late phase films confirmed a large umbilical vein filling from the left branch of the portal vein. So far as the author knows, umbilical haemorrhage as a complication of cirrhosis has never previously been reported.
Hypokalaemia in leukaemia
Authors: Nanji Amin A , Denegri Jorge
Published: December 2008

Five cases are presented which demonstrate the various factors contributing to the development of hypokalaemia and the relevant literature is briefly reviewed. Hypokalaemia is a common finding in leukaemia. Proper evaluation, adequate replacement of potassium and careful follow-up are necessary for prevention of potential dangers related to hypokalaemia.
Bronchial carcinoma presenting as autoimmune haemolytic anaemia
Authors: Cooper R , Tappin J A , Deveshevar S
Published: December 2008

A 68-year-old man presented with autoimmune haemolytic anaemia. Investigation revealed underlying bronchial carcinoma. A positive direct Coombs’ test failed to revert to negative after removal of the primary tumour. This suggested the presence of metastases which was subsequently shown. The possible significance and origin of the autoantibody is discussed.
Exercise-induced anterior tibial compartment compression syndrome in the elderly
Authors: Sweeney R C , Chadwick C J , Bagnall W E
Published: December 2008

Exercise-induced anterior tibial compartment compression syndrome occurs predominantly in young males. The authors report a case in a 79-year-old female as a complication of rehabilitation.
Low-dose insulin treatment of hyperosmolar diabetic coma
Authors: Wright A D , Walsh C H , Fitzgerald M G , Malins J M
Published: December 2008

The effect of low-dose hourly i.m. injections of insulin has been studied in the treatment of 17 episodes of hyperosmolar non-ketoacidotic diabetic coma compared with 26 episode of hyperosmolar ketoacidosis occurring in patients over 40 years of age. The fall in blood sugar was satisfactory in the majority of episodes of both types of coma and there was no evidence that patients with hyperosmolar non-ketoacidotic coma were more sensitive to insulin. The excess mortality in the non-ketotic group (47%) compared with the ketoacidotic group (16%) was not due to uncontrolled diabetes.
Carcinoma of the oesophagus associated with membrano-proliferative glomerulonephritis
Authors: Walker J F , O’Neil S , Campbell E , Browne O , Doyle G , Carmody M , O’Dwyer W F
Published: December 2008

Nephrotic syndrome has been observed in association with different types of neoplasia. This appears to be the first report of the occurrence of the nephrotic syndrome due to membrano proliferative glomerulonephritis in association with carcinoma of the oesophagus. Although proteinuria was present before excision of the tumour, the nephrotic phase occurred subsequently. Eventually it disappeared leaving the patient with a clear urine and biochemical and histological improvement of the renal lesion (including immunofluorescent and electronmicroscopy studies). Possible mechanisms responsible for the nephrotic syndrome in this case are discussed.
Recurrent colitis following antibiotic-associated pseudomembranous colitis
Authors: Davies John , Beck Eric
Published: December 2008

A patient who developed severe pseudomembranous colitis following clindamycin therapy, and who went on to have recurrent attacks of non-specific colitis, histologically confirmed over the following 19 months, is described.
Transient cerebral ischaemic attacks related to egg consumption
Authors: Ellis M E , Stevens David L
Published: December 2008

A 58-year-old man is described who suffered transient cerebral ischaemic attacks when on a diet containing a large number of eggs. When the egg content and, therefore, the cholesterol content of the diet was reduced the attacks stopped. It was concluded that the variations in his cholesterol intake and in his serum cholesterol, which remained normal or near normal throughout, are relevant to the aetiology of his episodes of cerebral ischaemia and that further study of techniques designed to alter the cholesterol intake and the cholesterol level in patients with such attacks may be useful.
Diabetic retinopathy in Cushing’s disease
Authors: Cassar J , Kohner Eva M , Joplin G F
Published: December 2008

A patient with proliferative diabetic retinopathy in long-standing Cushing’s disease is described.
Subdural abscess secondary to covert dental sepsis
Authors: Sprott Mae S , Hall K , Newman P K , Welbury R R , Ingham H R
Published: December 2008

The bacterial flora of a subdural abscess in a 17-year-old male, with radiological evidence of unilateral infection of the maxillary and frontal air sinuses, was typical of that encountered in the dental sulcus. Extensive examination revealed no primary focus of infection other than apical infection in the 2 upper first molar teeth, which were extracted. Treatment with ampicillin, gentamicin and metronidazole rapidly controlled the subdural infection, and resolution, as evidenced by computerized tomography, was complete at 10 months.
Distal pancreatectomy for spontaneous rupture of the splenic artery
Authors: Porter J M , Fenton O M
Published: December 2008

Two patients with haemoperitoneum due to spontaneous haemorrhage near the tail of the pancreas are described. One patient presented acutely with epigastric pain and was found to be bleeding from the main trunk of the splenic artery. The other presented with a prolonged history of epigastric pain culminating in a haematemesis and was found to have a partially organized haematoma in the tail of the pancreas. In both cases the bleeding was proximal to the splenic pedicle, and distal pancreatectomy with splenectomy was necessary to achieve haemostasis.
Reversible IgA deficiency in hypothyroidism
Authors: Eriksson Sten
Published: December 2008

A 50-year-old woman developed pronounced IgA-deficiency and hypothyroidism after 131I treatment for Graves’ disease. The deficiency state was associated with a severe sinobronchial syndrome. Treatment with L-thyroxine resulted in a normal IgA concentration and a dramatic clinical improvement. Of the various possible underlying mechanisms, impaired synthesis of IgA light and heavy light chains seemed most probable. Impaired production of J-chain was excluded.
Paroxysmal nocturnal haemoglobinuria with renal, infective and immunological abnormalities
Authors: Botelho R J , Sainsbury R , Ebrahim S B J , Bendall M J
Published: December 2008

An elderly woman presented with paroxysmal nocturnal haemoglobinuria complicated by renal failure which was almost completely reversible. The illness was further complicated by a transient cerebral ischaemic attack and a chest infection with septicaemia due to Pseudomonas aeruginosa from which she died.
Age, sex, ethnic origin and hospital admission for heart attack and stroke
Authors: Beevers D G , Cruickshank J K
Published: December 2008

The frequency of admission for heart attack and stroke in blacks, whites and Asians to Dudley Road Hospital, Birmingham, was studied. The study population (denominator) was 17 739 consecutive admissions to this hospital for the years 1975 to 1979, in 35- to 64-year-old men and women. Admission for heart attack was half as common in blacks compared with whites and, in some age groups, there was a slightly increased rate in Asians. By contrast, in both sexes and in all age groups, stroke admission was commoner in blacks. These differences cannot be explained by differing levels of blood pressure or cigarette smoking in the 3 ethnic groups.
Familial multiple myeloma. A review of thirty-seven families
Authors: Shoenfeld Y , Berliner S , Shaklai M , Gallant L A , Pinkhas J
Published: December 2008

The review of the pertinent literature disclosed 36 reports of familial multiple myeloma, described mostly in siblings, to which the authors add one more family. These patients did not differ significantly from those with non-familial myeloma with regard to sex, age, distribution of monoclonal proteins, clinical and laboratory data, and the course and prognosis of the disease. An increased incidence of immunoglobulin abnormalities was observed in healthy relatives of patients affected with familial myeloma. In most cases the time interval of the diagnosis of myeloma in a family member of a known patient was under 4 years. These observations, in conjunction with reports of myeloma occurring in clusters in a community and the appearance of myeloma in spouses raise the possibility of an environmental factor (virus?) which may contribute to the pathogenesis of myeloma in genetically predisposed individuals. Multiple myeloma should be added to the list of neoplastic diseases in which the family history is relevant and in which genetic and possibly environmental factors may be pathogenetically involved.
A comparison of antrafenine and aspirin on platelet aggregation and frusemide-induced diuresis
Authors: Hassan S M , Olivesi A , Fish A , Turner P
Published: December 2008

The effects of antrafenine were compared with aspirin and placebo on platelet aggregation and on the diuretic action of frusemide in normal volunteers. Aspirin significantly reduced platelet aggregation at 3 and 6 hr after administration, but antrafenine only at 3 hr. Only aspirin significantly reduced the increase in urine sodium and potassium produced by frusemide.
Osteoradionecrosis of the skull stimulating bone metastases
Authors: Kaplinsky N , Pines A , Tadmor R , Frankl O
Published: December 2008

Multiple skull erosions which simulated bone mestatases developed in a 54-year-old patient who had been treated for favus by radiotherapy 40 years earlier. Radiation necrosis should be recognized and differentiated from defects and erosions due to malignant or infectious process in order to prevent unnecessary procedures and treatment.
Tuberculous ulcer of the penis
Authors: Venkataramaiah N R , van Raalte J A , Dutta S N
Published: December 2008

Two cases of tuberculosis of the penis are presented because of the rarity of the disease. Stress is laid on the histopathological confirmation of the diagnosis of all penile ulcers before contemplating the line of treatment.
The clinical course of acute type A hepatitis in chronic HBsAg carriers—a report of 3 cases
Authors: Viola L A , Coleman J C , Barrison I G , Murray-Lyon I M
Published: December 2008

The clinical, virological, and biochemical course of 3 chronic HBsAg carriers who developed acute hepatitis A is described. Two of the patients had pre-existent chronic active hepatitis. The clinical course in each case was benign with resolution within one month, and there was a marked fall in HBsAg titre in one of the patients with chronic active hepatitis.
Isolated elevation of serum alkaline phosphatase and biliary disease in the elderly
Authors: Jones S N , Askew C M , Beynon G P J , Croker J R
Published: December 2008

Disease presentation is commonly non-specific in the geriatric age group. An isolated elevation of serum alkaline phosphatase concentration may be the only pointer to underlying biliary disease.
Cerebral aneurysm presenting with epilepsy
Authors: McCulloch David K , Ashworth Bryan
Published: December 2008

Two patients with cerebral aneurysm are reported. Both presented with temporal lobe epileptic attacks. In one of the patients there was a family history of aneurysm and cerebral haemorrhage. One aneurysm was recognized by calcification on a plain radiograph but could not be demonstrated by angiography during life. The aneurysms were large and originated from the middle cerebral artery. Previous reports are reviewed. Difficulties of diagnosis and prognosis are discussed.
Haemoperitoneum caused by a dissecting aneurysm of the left gastroepiploic artery
Authors: Gibb William R G , Archer Timothy J , van der Walt Jon D
Published: December 2008

A dissecting aneurysm of the left gastro-epiploic artery in a 79-year-old woman ruptured spontaneously into the peritoneal cavity. The insidious onset and the later progression to shock is discussed with relevance to the likely diagnoses. At laparotomy the aneurysm was excised.
Hypokalaemic myopathy following ileal resection
Authors: Lawrence Clifford
Published: December 2008

A patient developed an acute hypokalaemic myopathy due to persistent diarrhoea 4 months after a resection of ileum and a right hemicolectomy for carcinoma of the colon. The need for potassium supplements in the management of chronic diarrhoea following ileal resection is emphasized and the method of potassium replacement discussed.
Sleep apnoea occurring only in REM (possible relevance of the case for some cot deaths)
Authors: Beary M D , Crutchfield M B , Mintram M K , Crisp A H
Published: December 2008

A case of sleep apnoea occurring only within REM sleep in a 57-year-old man is described. It was successfully treated with clomipramine for a period. The patient probably had persistent phrenic nerve damage which accounted for, or contributed to, the phenomenon. It is suggested that this mechanism may operate in some cot deaths.
Symptoms and diagnostic delay in patients with carcinoma of oesophagus and gastric cardia: a retrospective study of 225 patients
Authors: Ojala K , Sorri M , Jokinen K , Kairaluoma M I
Published: December 2008

A retrospective review of 225 patients was made with regard to the symptoms of carcinoma of the oesophagus and gastric cardia, and the duration of the symptoms before medical attention was sought and before the establishment of the diagnosis. The age of the patients was 37-84 (mean 62·5) years (139 male, 86 female). The most common symptoms were dysphagia (93%), loss of weight (46%), vomiting (33%), gastric pain (25%) and thoracic pain (21%).

The average duration of the symptoms before the establishment of the diagnosis was 4·1 months in carcinoma of the oesophagus and 4·3 months in carcinoma of the gastric cardia. The patients with oesophageal disease had sought medical attention on average 5 weeks earlier than those with gastric disease. The role of the physician who initially examines the patient is decisive for early diagnosis.
Nodular purpura in infancy
Authors: Nagi N A , Al-Dubooni H M , Al-Shirkat S A R
Published: December 2008

Seventeen infants with nodular purpura are reported. All these infants suffered from a coagulation abnormality due to vitamin K deficiency. Contributing factors were breast-feeding, the use of milk substitutes, diarrhoea and antimicrobial therapy. The patients responded rapidly and completely to parenteral vitamin K. In the management of infantile diarrhoea use of antibiotics should be restricted to specific bacteriologically proven cases.

Vitamin K administration is suggested in infants with prolonged gastroenteritis and limited milk intake and particularly those receiving antibiotics.
Gastric ulcer healing by cimetidine in non-Hodgkin’s lymphoma of the stomach
Authors: Bendall M J , Sainsbury R
Published: December 2008

A man presented with what appeared clinically and histologically to be a benign gastric ulcer which healed with cimetidine. His condition subsequently deteriorated and a further endoscopy revealed a huge tumour in the body of the stomach with the histological appearances of non-Hodgkin’s lymphoma. The presentation of non-Hodgkin’s lymphoma in the elderly is discussed, together with the problem of gastriculcer healing by cimetidine in the presence of underlying malignancy.
Maternal blood glucose control and outcome of diabetic pregnancy
Authors: Wright A D , Nicholson H O , Taylor K G , Insley J , Evans S E
Published: December 2008

The results of management of 128 consecutive pregnancies occuring in diabetic patients who received insulin from before conception and throughout pregnancy are described. Mean maternal blood glucose levels were at least 1 mmol/litre greater than levels reported in normal pregnancy. Thirty-nine percent of the neonates had significant morbidity; respiratory distress syndrome (7·7%), hypocalcaemia (4·6%) and polycythaemia (10%) could be related to higher maternal blood glucose levels. Neonatal hypoglycaemia (9·2%), hyperbilirubinaemia (13·8%) and birth weight corrected for gestational age were not directly related to maternal blood glucose. This degree of maternal blood glucose control has reduced the large for dates infants (greater than 90th centile for gestational age) to 7%. Further reduction in the morbidity of infants of diabetic mothers requires studies of physiological maternal blood glucose levels which may not be possible with conventional insulin treatment as well as further efforts to reduce prematurity.
Limited joint mobility in Type I diabetes mellitus
Authors: Kennedy Laurence , Archer Desmond B , Campbell Sarah L , Beacom Rosalind , Carson Dennis J , Johnston Patrick B , Maguire Charles J
Published: December 2008

Forty-two of 115 patients with Type I (insulin dependent) diabetes were found to have limited joint mobility affecting mainly the small joints of the hands. The presence of joint abnormalities was related to duration of diabetes. Patients with limited joint mobility had a significantly higher incidence of proliferative retinopathy than patients with normal joint mobility and a similar duration of diabetes (P<0·001). Limited joint mobility appears to be an early marker for the development of microvascular complications in diabetes.
The glucagon test in obstructive and hepatocellular jaundice
Authors: Berstock David A , Wood John R , Williams Roger
Published: December 2008

The plasma glucose response to an intravenous bolus of glucagon was examined in patients with obstructive jaundice, hepatocellular jaundice and in healthy volunteers. Plasma glucose levels were determined before and at 15, 30 and 45 min after glucagon. The glucose response to glucagon differed markedly in the two patient groups with significantly higher plasma glucose values in the obstructive jaundice group.

Measurement of blood glucose after intravenous glucagon provides a simple test to assist in the differential diagnosis of obstructive and hepatocellular jaundice.
Clinical and biochemical effects of parachlorophenylalanine in a patient with the carcinoid syndrome
Authors: Bax N D S , Woods H F , Boulton A J M , Green A R
Published: December 2008

The clinical and biochemical features of a patient with flushing and severe diarrhoea due to the carcinoid syndrome are described. The patient had a paradoxical response to the tryptophan hydroxylase inhibitor parachlorophenylalanine with complete abolition of flushing and no effect on the diarrhoea. Treatment with this drug was limited by adverse effects.
Inflammation of a small bowel leiomyoma mimicking acute appendicitis
Authors: Hadley P A
Published: December 2008

Small bowel leiomyoma has been well documented as a cause of unexplained gastrointestinal bleeding. It has not previously been associated with frank peritonitis as described here.
Extrapyramidal and cerebellar syndrome with encephalopathy associated with cimetidine
Authors: Handler Clive E , Besse Christopher P , Wilson Adrian O
Published: December 2008

A possible case of cimetidine induced extrapyramidal and cerebellar features is reported. Although confusion is a well recognized toxic effect of cimetidine, other neurotoxic features are less common, especially in patients without evidence of renal or hepatic disease. Cimetidine should be used with great care and possibly in a reduced dose in the elderly as neuropsychiatric side effects may occur.
Bacteroides meningitis complicating chronic mastoiditis
Authors: Siegler D , Faiers M C , Willis A T
Published: December 2008

A 70-year-old man with a history of chronic middle and external ear suppuration presenting with acute meningitis due to Bacteroides uniformis is described. Anaerobic organisms including Bacteroides species were cultured from the affected external auditory meatus. Administration of metronidazole led to complete clinical recovery and a cholesteatoma was subsequently surgically evacuated. Chronic suppuration in the middle ear and paranasal sinuses is the commonest primary cause of cerebral abscess and in this setting meningitis is associated with a particularly high mortality. The major role of anaerobic sepsis in otolaryngological practice is well established. Metronidazole is the chemotherapeutic agent of choice.
Ventriculo-atrial shunt nephritis
Authors: Searle Martin , Lee H A
Published: December 2008

A case of immune complex glomerulonephritis with reversible renal insufficiency following ventriculoatrial shunting is described and the English language literature is reviewed. The importance of recognizing this reversible glomerulonephritic lesion is emphasized.
Fatal late-onset group B streptococcal sepsis on a special care baby unit
Authors: Hastings M J G , Rivers R P A , Easmon C S F
Published: December 2008

A 3-week-old preterm baby developed late-onset group B streptococcal sepsis and died, despite therapy with penicillin, granulocyte transfusions and fresh frozen plasma. Serotyping and phage typing results strongly suggested late acquisition of the organism from the mother. The baby had previously developed and recovered from an Escherichia coli bacteraemia.
Ptosis in systemic lupus erythematosus
Authors: Lanham John G , Elkon Keith B , Hughes Graham R V
Published: December 2008

Mild unilateral ptosis was observed in 11 women with systemic lupus erythematosus. It was associated with active disease in 8 patients, but only 2 had overt cerebral involvement. Isolated ptosis should not therefore be regarded as an indication of cerebral lupus.
Patients presenting with Addison’s disease need not be pigmented
Authors: Barnett A H , Espiner E A , Donald R A
Published: December 2008

Three consecutive cases of Addison’s disease without increased pigmentation are described. We suggest that the absence of this important physical sign contributed to serious delays in diagnosis and markedly increased morbidity. We emphasize that, despite the usual textbook description, excess pigmentation is not necessarily a feature of Addison’s disease.
Localized giant pseudo-polyposis in ulcerative colitis
Authors: Foster D R
Published: December 2008

Localized giant pseudo-polyposis is a rare complication of ulcerative or granulomatous colitis. A case illustrating the typical radiological findings is described. Recognition of this condition is important since it may simulate malignancy.
Pseudomembranous colitis following cephradine prophylaxis
Authors: Sankarankutty M , McGeorge D , Galasko C S B
Published: December 2008

Two patients on antibiotic prophylaxis with cephradine after orthopaedic implant surgery developed pseudomembranous colitis. Routine administration of antibiotics after such surgery is the policy at many centres. Development of diarrhoea in these patients should be viewed seriously lest this condition is overlooked. Despite recent advances, pseudomembranous colitis can still have a fatal outcome.
Neurological aspects of hyponatraemia
Authors: Daggett Peter , Deanfield John , Moss Fiona
Published: December 2008

Hyponatraemia is a common biochemical finding, but clinical features due to it are infrequent. They are most likely to occur when the plasma sodium concentration has fallen quickly to below 120 mmol/litre. In a study of 73 hyponatraemic individuals, it was possible to identify four categories of patient, the clinical features becoming more severe as the sodium level fell. In 25 instances there were no effects (mean plasma sodium 118\u00b73 mmol/litre), in a further 25 cases there was confusion only (mean plasma sodium 117\u00b71 mmol/litre), in 13 there were focal neurological signs and in 10 there were convulsions (mean plasma sodium 110\u00b78 mmol/litre). In the group with convulsions there were six deaths, the four survivors all being young women. The 13 cases of \u2018focal\u2019 neurological signs included three instances each of hemiparesis and monoparesis, seven of extra-pyramidal disturbance and six of cerebellar ataxia. All these abnormalities resolved when the plasma sodium concentration rose to 125 mmol/litre.

Active measures to raise the plasma sodium level are only needed when there have been convulsions and the aim should be to achieve a value no higher than 120 mmol/litre. In other cases, the only treatment required is to restrict fluid intake.
Bone and joint tuberculosis: phthisis changes course
Authors: Gawkrodger David J , Cole R B
Published: December 2008

Eighteen cases of bone and joint tuberculosis occurred in North Staffordshire between 1976 and 1980. The immigrant population is small and the disease was commonest in whites over 60 years old. There were only three cases of spinal tuberculosis. A lack of uniformity was found in the chemotherapeutic regimens used.
The incidence of the dumping syndrome following gastrojejunostomy with Roux-en-y anastomosis
Authors: Cade Richard J , Kilby John O
Published: December 2008

A clinical study was undertaken to determine the incidence of the dumping syndrome following partial gastrectomy and Roux-en-y gastrojejunostomy. Twenty-three patients were scored according to a clinical diagnostic index. There were no dumpers identified. A theoretical explanation for these findings is offered. A Roux-en-y conversion should be considered for patients with disabling dumping symptoms following gastric surgery.
Hypothalamic-pituitary disease as the sole manifestation of sarcoidosis
Authors: Lawton F G , Beardwell C G , Shalet S M , Daws R A
Published: December 2008

Hypothalamic-pituitary disease is a well-recognized, although uncommon, occurrence in sarcoidosis. Almost always the endocrine manifestations occur in a patient with widespread disease involving the lungs, skin or liver. A case is reported of central nervous system (CNS) sarcoidosis with no other clinical, biochemical or histological evidence of the disease.
Impaired ACTH and glucagon response to hypoglycaemia in an insulin-treated diabetic
Authors: Ohwovoriole A E , Bevan J , Nairn I M , Baird J D
Published: December 2008

A 32-year-old woman who had been diabetic for 24 years presented with frequent, oligosymptomatic episodes of hypoglycaemia. Investigations showed that she had attenuated adrenocortical and pancreatic A-cell response to hypoglycaemia. Her plasma ACTH response to hypoglycaemia was also impaired but there was normal adrenocortical response to the injection of synthetic ACTH. Plasma glucagon response to intravenous arginine was also normal.

It is concluded that the blunted plasma cortisol response to insulin-induced hypoglycaemia in some long-standing diabetics is due to a pituitary or higher dysfunction, rather than adrenocortical dysfunction.
The Japanese plasma cell dyscrasia syndrome: case report and theory of pathogenesis
Authors: Tobin Martin J , FitzGerald Muiris X
Published: December 2008

A 54-year-old man developed pigmentation, clubbing, weight loss, oedema, hepatomegaly, lymphadenopathy, cold intolerance, hypotonia and hyporeflexia. Dominant laboratory findings were increased marrow plasma cells with IgA lambda paraproteinaemia, hypothyroidism, hyperprolactinaemia, hyperoestrogenaemia and biopsy-proven peripheral neuropathy. The clinical features and dramatic response to corticosteroids are consistent with the syndrome of plasma cell dyscrasia, polyneuropathy and endocrinopathy found predominantly in Japan. In our patient, immunofluorescence of neural tissues revealed paraprotein deposition. Although the pathogenesis is unknown, these multisystemic features may result from antibody activity or tissue deposition of paraprotein. Furthermore, the endocrinopathy may be localized at the hypothalamic level.
Multiple tumour emboli simulating a massive pulmonary embolus
Authors: Hadfield J W , Sterling J C , Wraight E P
Published: December 2008

A 27-year-old man presented with shortness of breath due to multiple pulmonary emboli. At post-mortem the emboli consisted entirely of secondary epithelioid sarcoma, the primary having been resected 5 years previously.
Plasma ranitidine concentrations after intravenous administration in normal volunteers and haemodialysis patients
Authors: Roberts A P , Harrison C , Dixon G T , Curtis J R
Published: December 2008

A comparison was made of the plasma concentrations of ranitidine base in 12 normal volunteers after the administration of 100 mg intravenously and in 6 patients with terminal renal failure after 40 mg intravenously off and then during haemodialysis. The plasma ranitidine concentrations were determined by radioimmunoassay. The results suggest that reduced elimination of the drug occurs in patients with severe renal failure and that there is significant removal of the drug during haemodialysis. It is suggested that dosage reduction is advisable in patients with severe renal failure and a suitable schedule for such patients is described.
Prolonged remission in Di Guglielmo’s syndrome
Authors: Carr R , Innes E M
Published: December 2008

A case is reported of a 12-year-old boy with Di Guglielmo’s syndrome who achieved complete remission for over three years before developing a central nervous system relapse. The poor results of treatment in this disease are reviewed and the arguments for routine central nervous system prophylaxis discussed.
Hypertrophic osteoarthropathy without radiographic evidence of new bone formation
Authors: Amin R
Published: December 2008

A 70-year-old man with florid symptoms of hypertrophic osteoarthropathy for over a year presented without radiographic evidence of new bone formation. His symptoms improved after exploratory thoracotomy, but recurred with lesser severity a year later with tumour recurrence on the chest wall. Absence of new bone formation was again demonstrated radiologically as well as by isotope scan.
Bilateral spontaneous pneumothorax in sarcoidosis
Authors: Ross Richard J M , Empey D W
Published: December 2008

Sarcoidosis, early in the disease, is rarely complicated by pneumothoraces. We report a case of simultaneous bilateral spontaneous pneumothoraces affecting a young man with early sarcoidosis.
An unusual case of Pasteurella multocida septicaemia
Authors: Penketh C
Published: December 2008

A patient with recurrent septicaemic episodes due to Pasteurella multocida complicated by vertebral osteomyelitis and pseudo-membranous colitis is described.
Primary hepatocellular carcinoma arising in a renal transplant recipient with polycystic disease
Authors: Gardner B P , Evans D B
Published: December 2008

Malignant disease arises more commonly in renal transplant recipients than in non-transplanted individuals. Renal polycystic disease is the only cause of renal failure that has a statistically significant association with the acquisition of malignancy in renal transplant recipients. This patient, who had renal failure due to polycystic disease, is the first reported renal transplant recipient to develop a hepatocellular carcinoma in an otherwise completely normal liver. It is suggested that patients with polycystic renal disease may have an unidentified factor that predisposes to the development of malignancy in them after transplantation.
The BTPABA pancreatic function test in giardiasis
Authors: Okada M , Fuchigami T , Ri S , Kohrogi N , Omae T
Published: December 2008

The test for exocrine pancreatic function using N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BTPABA test) was assessed in 7 patients with giardiasis and 7 healthy controls. Cumulative percent p-aminobenzoic acid (PABA) recovery in 6 hr was significantly lower in patients with giardiasis, compared with the control group. When an equivalent dose of free PABA was given, there were no differences in PABA recovery between the groups. In patients with giardiasis, the post-treatment values of BTPABA test were significantly higher than the pretreatment values and no differences were found in PABA recovery between patients with giardiasis after eradication and healthy controls. These findings indicate that Giardia lamblia interferes with the action of pancreatic chymotrypsin. It is noteworthy that giardiasis could cause an abnormal BTPABA test.
The pharmacokinetics of lysine theophylline, a new soluble theophylline, in human volunteers
Authors: Johnston A , Aldhous M E , Hedges A , Weerasuriya K , Freedman A , Turner P
Published: December 2008

A comparative study of the pharmacokinetics of lysine theophylline and aminophylline in normal subjects reveals no significant difference. If lysine theophylline is shown to have the same clinical efficacy as aminophylline, the hypersensitivity reactions associated with the latter could be avoided.
Anterior mediastinal haematoma and left haemothorax on well-controlled oral anticoagulant therapy
Authors: Abaskaron M , Peterson G , Huang T Y
Published: December 2008

An anterior mediastinal haematoma and left haemothorax developed in a hypertensive diabetic patient on oral anticoagulant therapy. This occurred in spite of well-controlled anticoagulation and the absence of other evidence of systemic bleeding.

Angiography and daily chest X-ray follow-up were not only sufficient to confirm the diagnosis, but also avoided hazardous interventional procedures.
Opening remarks
Authors: Olsen E G J
Published: December 2008

When we originally set up the multicentre research project on endomyocardial disease, late in 1978, we held a small workshop, attended by only three of the six participating centres, designed to discuss how best to tackle this problem. We decided not to publish the proceedings of that meeting. This was regretted by many and so, on this occasion, I suggested we rectify our initial omission and publish the proceedings of this workshop, attended by representatives of all but one of the participating centres.
The cardiotoxicity of eosinophils
Authors: Spry Christopher J F , Tai Poh-Chun , Davies John
Published: December 2008

Although an association between high blood eosinophil counts and endomyocardial disease has been known for nearly a hundred years, the reasons for this were not understood. Brockington, Luzzatto and Osunkoya (1970) suggested that eosinophil leucocytes, in susceptible persons, by some unknown mechanisms, cause endomyocardial damage. Evidence to support this possibility has come from three sources: (1) Clinical studies have shown that very high blood eosinophil counts, from any cause, can be associated with endomyocardial disease, and in some patients it has been possible to show that eosinophilia preceded the onset of heart disease. (2) The development of heart disease has been associated with the presence of degranulated eosinophils in the blood and tissues, including damaged endomyocardium, and raised serum levels of eosinophil granule basic proteins have been found in many of these patients. (3) Low concentrations of eosinophil secretion products (which contain these eosinophil granule basic proteins) have been found to injure isolated heart cells in vitro. Studies with purified eosinophil granule basic proteins have shown that cardiac cell damage is the result of a specific toxic effect of eosinophil cationic protein on the plasma membrane and two enzyme complexes (pyruvate dehydrogenase and 2-oxoglutarate dehydrogenase) involved in mitochondrial respiration. These results support the suggestion that under certain conditions, eosinophils may damage the heart, leading to endomyocardial disease, and they offer new approaches for the early diagnosis and treatment of endomyocardial disease both in temperate and tropical countries.
Summary
Authors: Goodwin J F
Published: December 2008

We heard, to begin with, an excellent description of the pathology of endomyocardial disease with regard to the endocardium, the myocardium and the gross pathological appearances at microscopy and so on. It appeared certain from Professor Hutt’s paper that there are differences in epidemiology in the tropical as opposed to temperate zone varieties.
Staphylococcal suppurative mesenteric lymphadenitis
Authors: Jain S K , Khanna S K
Published: December 2008

Two young adult males presenting with suppurative mesenteric lymphadenitis, caused by coagulase positive staphylococcus, with unusual clinical findings are reported. Pre-operative and operative differential diagnosis and management are discussed. Previous publications are briefly reviewed. The condition is extremely rare in adults and the pathogenesis is not well understood.
Constrictive pericarditis and intestinal haemorrhage due to Whipple’s disease
Authors: Crake T , Sandle G I , Crisp A J , Record C O
Published: December 2008

Two months after a pericardectomy for constrictive pericarditis a 37-year-old man presented with diarrhoea, abdominal pain and weight loss. During the course of investigation he developed brisk rectal bleeding and emergency angiography revealed a bleeding site related to an area of abnormal vasculature in the caecum. At laparotomy, the small bowel was found to be inflamed and the mesenteric lymph nodes enlarged. The overall histological appearances, confirmed later on endoscopic duodenal biopsies, were those of Whipple’s disease. His symptoms resolved promptly after starting tetracycline therapy.

The clinical features of Whipple’s disease are protean and often bizarre. We report here a case where the diagnosis was made after the onset of profuse rectal bleeding.
Eradicating sources or removing results
Authors: Burkitt Denis P
Published: December 2008

With few exceptions, the prevalence of disease has never been reduced by improved treatment. Success has followed identifying and eliminating, or reducing, causative factors. This has been true of infective disease in the West and of the great tropical epidemics. Yet vastly greater endeavour and expenditure are devoted to the treatment of non-infective diseases than to efforts to identify and tackle their causes. This in spite of the fact that they are increasingly recognized as characteristic of modern western culture.
The regulation of vasopressin secretion in a patient with oat cell carcinoma of the bronchus
Authors: Spruce Barbara A , Baylis P H
Published: December 2008

We report a patient who had an oat cell bronchogenic carcinoma in association with the syndrome of inappropriate antidiuresis. There was an unusually long interval between the onset of hyponatraemia and clinically evident malignant disease. Dynamic testing of vasopressin secretion showed preservation of baroregulated, but not osmoregulated, vasopressin release. Immunoreactive vasopressin was detected in pleural fluid, which co-eluted with synthetic vasopressin on gel chromatography.
Pseudoerythrocytosis in myeloma with associated peripheral neuropathy
Authors: Lockhart S P , Phaure T A J
Published: December 2008

A number of unusual features have been described in patients who have peripheral neuropathy in association with plasma cell neoplasia. Amongst these features are raised haemoglobins and increased platelet counts. We have measured the red cell mass in one such patient and have shown that the raised haemoglobin was due to a pseudoerythrocytosis. Our patient is also of interest because of his youth being only 19 years old at presentation.
Recent advances in pancreatic hormone research
Authors: Long R G
Published: December 2008

The pancreas secretes 4 major polypeptide hormones: insulin from the beta cells; pancreatic glucagon from the alpha cells; somatostatin from the D cells in the islets of Langerhans, and pancreatic polypeptide (PP) from the PP cells which are spread more diffusely through pancreatic exocrine and endocrine tissue. Some or all of these 4 hormones may also have paracrine effects; this means that the peptide is secreted locally and has metabolic effects on neighbouring cells. Gastrin is synthesized in G cells in the foetal pancreas, but these cells disappear postnatally. Certain other polypeptides such as vasoactive intestinal polypeptide (VIP) have also been demonstrated in human pancreas, but appear predominantly localized to nerves; these substances, which were initially classified as ‘gut hormones’, are now thought to be neurotransmitters or neuromodulators of the non-adrenergic, non-cholinergic branch of the autonomic nervous system. In view of the multiple modes of actions of these peptides, the descriptive term ‘regulatory peptides’ is now often used. Basic information about the peptides to be discussed is listed in Table 1, but it should be emphasized that many of them exist in multiple molecular forms. The purpose of this review is to discuss some primarily non-diabetic aspects of the physiology and pathophysiology of pancreatic polypeptides which have recently received attention.
Bone disease after jejuno-ileal bypass for morbid obesity
Authors: Gilmore I T , Eastwood J B , Ellis W R , Luck V A , Fenton S , O’Grady A J , Harris E , Murray-Lyon I M
Published: December 2008

Fifteen patients who had undergone a 14 inches X 4 inches jejuno-ileal bypass operation for obesity, 3 to 4 years earlier, were investigated by iliac bone biopsy, radiology and routine biochemistry, including 25-hydroxy-vitamin D and parathyroid hormone estimations. Two patients had histological osteomalacia which was mild in one. A further 9 patients had abnormal bone biopsies, there being an excess of trabecular bone surface covered by osteoid with a normal or reduced amount of calcification front. Six of these 9 showed an increase in trabecular resorption, although in none were there excessive numbers of osteoclasts. The likely explanation for these findings is that these 9 patients had early osteomalacia with mild hyperparathyroidism, making a total of 11 patients out of 15 with osteomalacia. Radiology and blood chemistry were poor predictors of histological bone disease.
Primary immunoglobulin deficiency and haematological disorders
Authors: French M A H , Dawkins R L , Jackson J M
Published: December 2008

Nine patients with immunoglobulin deficiency and various haematological disorders are presented. In all patients, recurrent infections had antedated the onset of the haematological disorder but, in most, the possibility of primary immunodeficiency had not been considered until after the haematological diagnosis had been established. The recognition of immunodeficiency is important since such patients may require steroids, immunosuppressive therapy or splenectomy. Gammaglobulin would appear to be the appropriate therapy in this situation. Infections were reduced in all 6 patients so treated.
Paraquat poisoning: evidence of systemic toxicity after dermal exposure
Authors: Tungsanga K , Chusilp S , Israsena S , Sitprija V
Published: December 2008

Exposure of the scrotal skin to a concentrated paraquat solution led to renal and respiratory failure and to hepatic damage with eventual recovery of the patient. Dermal exposure to paraquat, especially to the scrotum may produce serious systemic toxicity.
Simplified intravenous nutrition using Intralipid-based mixtures in patients with serious gastrointestinal disease
Authors: Burnham W R , Knott C E , Cook J A , Langman M J S
Published: December 2008

An Intralipid-based intravenous feeding mixture has been given to 20 patients with serious gastrointestinal disease who required parenteral nutritional support (mean duration 13.75 days). In half of the patients, only peripheral veins were used for infusion (mean duration 12 days), the infusion site being changed every 24-48 hr. Positive nitrogen balance was maintained in all but one individual and other parameters of nutrition improved. No serious complications due to intravenous feeding were encountered, although some patients did develop abnormal liver function tests and mild phlebitis at the peripheral vein infusion site. No abnormalities of pulmonary gas exchange attributable to the infusion were noted.

We conclude that this mixture is safe, relatively simple to use and effective. Consequently, it may be especially appropriate for patients in general medical and surgical wards as well as those in specialist units.
Radiculomyelopathy associated with herpes simplex genitalis treated with adenosine arabinoside
Authors: Handler Clive E , Perkin G D , Fray R , Woinarski J
Published: December 2008

A case of herpes simplex genitalis producing radiculomyelopathy with urinary retention is reported. The patient was treated with adenosine arabinoside intravenously and made a complete recovery over 4 weeks. Although herpes simplex genitalis is common, neurological sequelae, particularly cord involvement, are distinctly rare. It should, nevertheless, be considered in the differential diagnosis of urinary retention, with or without long-tract signs, in young patients.
Malignant melanoma of the gallbladder
Authors: Anderson J B , Hughes R G , Williamson R C N
Published: December 2008

We report a case of primary malignant melanoma of the gallbladder with review of the literature and comment on the frequency of secondary deposits of melanoma within the small bowel.