bluuebunny/crossref_metadata_2025 huggingface dataset:
The effects of supplementary nicotine in regular cigarette smokers
Authors: Turner J A M , Sillett R W , Taylor D M , McNicol M W
Published: December 2008

Blood nicotine levels were measured in eight subjects over a 5-week period, while smoking normally, while smoking and chewing gum containing 2 mg nicotine, and while smoking and chewing placebo gum. Despite a small but significant rise in blood nicotine levels during the period of the nicotine gum chewing (mean 35.3 ng/ml) compared with placebo (mean 28.9 ng/ml) and control (mean 26.3 ng/ml), cigarette consumption butt lengths, filter nicotine and blood carboxyhaemoglobin levels did not change indicating that there had been no significant changes in smoking patterns. The reasons for this failure to demonstrate an effect are discussed. It is concluded that the dose of nicotine used was probably not adequate to produce an effect.
Effect of propranolol on glucose tolerance in hyperthyroidism
Authors: Harrower A D B , Nairn I M , Strong J A
Published: December 2008

Glucose tolerance tests were performed on six hyperthyroid patients in the morning and afternoon before, and at the end of treatment with propranolol for 2 weeks. All six subjects showed normal glucose tolerance with a normal diurnal rhythm before treatment and this remained normal in five during treatment with propranolol, while one patient developed abnormal glucose tolerance and the diurnal variation was abolished. No change in insulin levels was noted in any of the patients either before or during treatment. Propranolol may cause deterioration in glucose tolerance in some subjects with hyperthyroidism and this possibility should not be overlooked.
Papilloedema associated with respiratory failure
Authors: Pye I F , Blandford R L
Published: December 2008

A case of papilloedema secondary to respiratory failure is reported which caused considerable diagnostic difficulty and led to extensive neurological investigation. Neurological complaints of headache and visual impairment overshadowed respiratory symptoms and were associated with gross haemorrhagic papilloedema. The case is compared with previous reports and the pathogenesis of papilloedema in respiratory failure is reviewed briefly. The similarity between the pathogenesis of this condition and benign intracranial hypertension is discussed.
Miliary tuberculosis and disseminated aspergillosis
Authors: Solomon L R , Harris M
Published: December 2008

A patient with concurrent miliary tuberculosis and disseminated aspergillosis is described.
Physiology of abnormal movements
Authors: Marks J
Published: December 2008

The units of the central nervous system controlling voluntary movement are described and the roles of the motor and sensory cortex, of the basal ganglia and cerebellum and of the final common loop are outlined. The pathophysiology underlying disturbances of movement, power and tone of the limbs is discussed, with particular reference to the more common dyskinesias.
Symptomatic Parkinsonism
Authors: Pearce J
Published: December 2008

Parkinson's disease, 'paralysis agitans', is characterized by a number of abnormalities. A similar clinical picture may be symptomatic of other disturbances: these are briefly described and the differential diagnosis is discussed.
Urticaria—current concepts
Authors: Taaffe A
Published: December 2008

The mechanisms, clinical features and management of the various forms of urticaria are discussed. The importance of histamine receptors, complement and the kinin cascade are reviewed.
Ultrasound in the diagnosis and measurement of aneurysms of the abdominal aorta
Authors: Sutton D , Garner R G
Published: December 2008

One hundred cases clinically diagnosed as aneurysm of the abdominal aorta were examined by ultrasound. The findings are described and the value and limitations of the method assessed.
Cimetidine in the management of the Zollinger-Ellison syndrome
Authors: Larkworthy W , Davies H L
Published: December 2008

The first case of the Zollinger-Ellison syndrome treated from the outset continuously for more than a year with the histamine H2-receptor antagonist cimetidine is reported. Symptomatic response has been dramatic and sustained, marked endoscopic improvement has been observed with healing of oesophageal, gastric and stomal ulcers.
Thrombophlebitis migrans in ulcerative colitis
Authors: Camilleri M , Fenech F F
Published: December 2008

A case of thrombophlebitis migrans in ulcerative colitis in a Maltese housewife is reported. The association of thrombo-embolic disease and ulcerative colitis is reviewed.
Leukaemoid reaction in a case of leiomyosarcoma of the bladder
Authors: Narayana A S , Kelly D G , Duff F A
Published: December 2008

The first case of leiomyosarcoma of the urinary bladder associated with leukaemoid reaction is herein presented. There was no secondary involvement of bone marrow to explain the leukaemoid reaction. It may have been due either to tumour necrosis or to an unknown humoral substance elaborated by the tumour.
Effect of noxythiolin on experimental peritonitis
Authors: Gilmore O J A , Houang E T , Reid C , Shaw E J
Published: December 2008

The intraperitoneal instillation of noxythiolin in the treatment of peritonitis is widespread in clinical practice despite contradictory evidence as to its efficacy. In this light the value of noxythiolin was reappraised by studying its effect in guinea-pigs and mice with induced bacterial peritonitis. Treatment with a 1% solution of noxythiolin reduced the mortality rate of mice by 14% (P<0·1). The guinea-pig model proved unreliable giving inconsistent mortality rates throughout. Further studies are required to determine the optimum dose and concentration of noxythiolin while the search for more effective intraperitoneal antiseptics should continue.
Whipple's disease in a female with impaired cell-mediated immunity unresponsive to co-trimoxazole and levamisole therapy
Authors: Haeney M R , Ross I N
Published: December 2008

A case of Whipple's disease in a female is described. Malabsorption of iron, vitamin B12, folic acid and fat was present. These abnormalities reverted to normal after introduction of co-trimoxazole therapy. The patient's humoral immune system was normal, in contrast to impairment of cell-mediated immunity, which has not improved in spite of co-trimoxazole treatment for 2 years, and a therapeutic trial of levamisole.

These findings are further evidence that there may be a primary immune deficiency in patients with Whipple's disease.
Roundworm granuloma of the anterior abdominal wall
Authors: Chandrasoma P T , De Silva S , Yoganathan M
Published: December 2008

A case of migration of a gravid female roundworm into the peritoneal cavity is reported. The presenting feature, a lump in the anterior abdominal wall, has not previously been documented. Fertilized ova of the worm were found in miliary peritoneal granulomata, and showed development up to the eight-cell stage.
Phenobarbital dyskinesia
Authors: Lightman S L
Published: December 2008

A patient was admitted to hospital following an overdose of phenobarbital. During her recovery she developed both chorea and torsion dystonia which could only be related to her high plasma phenobarbital levels.
Cardiac rupture in post-myocardial infarction syndrome
Authors: Hislop W S
Published: December 2008

A fatal case of post-myocardial infarction syndrome (PMIS) followed by a rupture of an inferior left ventricular aneurysm is described. Attention is drawn to the growing number of reports of aneurysm in PMIS, and the clinico-pathological significance of this association is discussed.
Penetration into bone and tissues of clindamycin phosphate
Authors: Baird P , Hughes S , Sullivan M , Willmot I
Published: December 2008

Clindamycin phosphate is an antibiotic which is effective against both Staphylococcus aureus and the anaerobic organisms. In thirteen patients, its concentration following joint replacement was measured by the agar diffusion method. In bone, the concentration was (mean ± s.e. mean) 5·01 microgram/ml ± 1·16, N=10; in capsule, 3·29 microgram/ml ± 0·71, N=12; measured between 1·75 and 3·75 hr after intramuscular and intravenous injections, and in drainage fluid it amounted to 4·61 microgram/ml ± 0·38, N=11 in 48 hr. Two patients developed diarrhoea which settled within a short period.
Plasma concentration/time curve of erythromycin after a 12-hour intravenous infusion of erythromycin lactobionate in man
Authors: Parsons R L , Paddock Gillian M , David Jill , Stamp S T
Published: December 2008

As the pharmacokinetics after a slow infusion had not previously been evaluated in the doses used in this study, it was decided to measure the plasma concentration/time curve after a twelve-hour intravenous infusion of 2·0 g of erythromycin lactobionate in 2 litres of 0·9% normal saline. Six healthy medical students with no past history of cardiovascular, renal, hepatic, metabolic or gastrointestinal disease and no past drug allergy participated. The concentration of erythromycin base in venous blood was measured by small plate microbiological assay. Venous blood was taken at zero, 15, 30, 45, 60 min and at 2, 3, 4, 6, 8, 12, 16, 20 and 24 hr after starting the infusions. Duplicate assays were performed on all plasma samples at Guy's and at the manufacturer's laboratories. A full haematological and biochemical screening profile was performed before and after the study.

The mean ± s.e. plasma erythromycin base concentration rose from 0·7 ± 0·2 μg/ml at 15 min to 6·06 ± 1·6 μg/ml at 1 hr. The peak plasma concentration was between 1·48 ± 0·25 μg/ml at 30 min and 7·21 ± 0·93 μg/ml at 4 hr. The plasma concentration at 12 hr was 6·17 ± 0·33 μg/ml, and fell to 0·37 ± 0·05 μg/ml at 24 hr.

These findings suggest that therapeutically effective plasma concentrations follow a slow intravenous infusion of erythromycin lactobionate. There was no evidence of adverse haematological or biochemical function in the tests of blood, hepatic or renal function, apart from two volunteers who vomited after the infusions were discontinued.
Differentiation of irregular rhythms by frequency distribution analysis
Authors: Talbot S , Dreifus L S
Published: December 2008

Distinctive electrocardiographic patterns for atrial fibrillation, sinus rhythm and atrial extrasystoles, sinus arrhythmia and atrial flutter were found by analysing the frequency distribution of cycle lengths of the electrocardiogram.

Frequency distribution analysis, demonstrated that atrial fibrillation is not completely irregular, but shows more long cycles than expected by chance and often a mode at the lower end of the distribution. Irregular atrial flutter is similar. Sinus arrhythmia has more variable organization, but usually there is a centrally situated mode with decreasing observations to the two extremities, and positive skewing. Examples of sinus rhythm and atrial extrasystoles usually have a mode at the upper end of the distribution with a secondary concentration of observations at the lower extremity.

Ratios derived from the frequency distributions were of value in differentiating these arrhythmias.

It is suggested that such information will improve computer identification of arrhythmia.
Preparations used for the artificial feeding of infants
Authors: Widdowson E M
Published: December 2008

Cow's milk differs from human milk in a number of important ways, and manufactures of dried milk preparations for infants have used various methods to make the composition of the diluted product more like that of human milk. The first was to add lactose, or to recommend the mother to add sucrose. This not only increased the carbohydrate, but also ‘diluted’ the protein and inorganic constituents which are more concentrated in cow's than in human milk. The second was to replace all or part of the cow's milk fat with animal and vegetable fats, and so make the fatty acid composition more like that of human milk fat. In particular the proportion of linoleic acid was increased and that of stearic acid decreased, and this made the fat more easily digested and absorbed by the young infant. The third modification of cow's milk has been more fundamental. Its aim has been to make a product containing less sodium and phosphorus than cow's milk and with a higher lactalbumin: casein ratio. Whey, which contains lactalbumin but not casein, is used as the starting material. This is dialysed to remove soluble inorganic constituents. Some skimmed milk is then added to supply casein and some minerals, and the composition is adjusted as required with further minerals and vitamins. Lactose is added and a mixture of animal and vegetable fats.

Dried milks on sale in Britain contain added vitamins A,D, and C and also iron. Some have added copper and zinc.
Normal and abnormal lipid metabolism in children
Authors: Lewis B
Published: December 2008

The transport of lipids in plasma, and its dietary regulation are briefly reviewed. Plasma lipid concentrations are low in the neonate, rising to near-adult levels by the age of six years. The causes of childhood hyperlipidaemia are discussed and a classification is proposed.
Motivating adolescents to reduce risk for chronic disease
Authors: Williams C L , Wynder E L
Published: December 2008

Motivating children to reduce risk for future disease can only be effective within a framework of personal involvement and peer interaction. The ‘Know Your Body’ programme of disease prevention is attempting to achieve this goal by means of medical screening for risk factors, giving students their own results in a ‘Health Passport’, and following up with educational activities integrated into existing school curricula. Didactic teaching alone has been unsuccessful because children cannot relate information about diseases in adult life to themselves. Screening for risk factors provides the ‘reality factor’ which makes health education pertinent and personal, since approximately half of all students screened will already have one or more risk factors for heart disease, cancer or stroke. This high prevalence of risk factors among our children suggests that chronic-disease prevention must assume a critically important position within the health and science curricula of every school. It is as important to teach our children healthy ways of living as it is to teach reading, writing, and arithmetic.
A national food policy for prevention of CHD?
Authors: Miller D , Truswell A S
Published: December 2008

There is an increasing recognition of the importance of diet in the prevention of CHD. Dietary recommendations of various authoritative bodies are summarized. There is now a concensus of opinion concerning certain nutritional changes needed. These have important implications for education, agriculture, food labelling and food subsidies. It is concluded that a national food policy is needed, but that this should come from education and persuasion and not from compulsion.
The attitude of the food industry
Authors: Green J
Published: December 2008

The food industry necessarily provides what the nation will eat. Whilst taking care to meet all the standards laid down, the industry has to follow fashion rather than to dictate it. It welcomes advice from the medical profession but much advice has been slow to come. In this spirit of co-operation the food industry accepts its role to feed the nation and does so with responsibility for health and hygiene.
Physical exercise and the prevention of atherosclerosis and cholesterol gall stones
Authors: Simko Vlado
Published: December 2008

There is accumulating evidence in man and experimental animals that even mild exercise, if regularly repeated, may alter the metabolism of lipids. Exercise has been reported as decreasing peripheral tissue cholesterol in red blood cells, working muscle, lungs and the liver. During physical activity, the output of cholesterol and bile acids into the bile increases. This probably leads to higher faecal losses of sterols which may lead to lower cholesterol levels in the peripheral tissues and in the bile, when exercise is repeated regularly. Preferential release of unsaturated fatty acids from the adipose tissue during exercise and the linoleic acid-dependent LCAT enzyme (transporting plasma cholesterol) may be partly responsible for this effect of exercise. The experimental data reviewed provide supportive basis for epidemiological studies reporting on the beneficial effect of regular exercise.

Physical activity is an important factor in the phylogeny of all animal species, secondary only to food intake and reproduction. Exercise is readily available to all population groups. There is good evidence that the amount of exercise required for a protective effect is easily accessible for time-pressured and older individuals. Short bursts of activity repeated several times a day may be equally or more beneficial than prolonged exhaustive exercise. Modified exercise is also beneficial for patients with coronary heart disease and for elderly patients, provided this is done under strict medical supervision. To be effective, physical exercise should be regular and continuous throughout life.
Normal alkaline phosphatase in primary biliary cirrhosis
Authors: Leslie D
Published: December 2008

A patient with primary biliary cirrhosis is described. Throughout her illness the serum alkaline phosphatase remained normal and this unique feature emphasizes the importance of histology in diagnosing the disease.
Echocardiography in a district general hospital
Authors: Pollick C
Published: December 2008

A referral service for echocardiography was established in a district general hospital. One hundred and three patients were studied and the benefits to defined groups of referrals were evaluated. It is concluded that the introduction of echocardiography into this setting is of advantage to many patients with cardiac disease and should therefore be encouraged.
Oral methionine loading as a cause of acute serum folate deficiency: its relevance to parenteral nutrition
Authors: Connor H , Newton D J , Preston F E , Woods H F
Published: December 2008

Oral methionine supplements (8.0 g daily for 4 days) were given to five normal volunteers who continued to eat their usual diet. This treatment resulted in a significant fall in serum folate concentration. Three days after the end of treatment concentrations had not completely returned to control values. The fall in concentration was prevented by giving oral folic acid supplements. It is suggested that folic acid supplements should be given to patients who are receiving intravenous infusions of amino acid mixtures.
Therapy of Candida peritonitis: penetration of amphotericin B into peritoneal fluid
Authors: Peterson L R , Kelty R H , Hall W H , Votava H J
Published: December 2008

Candida albicans peritonitis developed in a 48-year-old man with a perforated gastric ulcer who subsequently was treated with intravenous amphotericin B. The drug penetrated well into the inflamed peritoneal cavity and eradicated the organism from the peritoneal fluid. Nevertheless, at post-mortem, Candida organisms were demonstrated in a gall-bladder empyema and within the gall-bladder wall. Because intra-abdominal organs may be involved in Candida peritonitis, the use of high dose amphotericin B administered either intravenously, intraperitoneally, or both intravenously and intraperitoneally is recommended.
Recurrent meningitis and brain abscess caused byEikenella corrodens
Authors: Emmerson A M , Mills F
Published: December 2008

A case of recurrent menigitis and brain abscess caused by Eikenella corrodens in a patient with previous otitis media and mastoidectomy.
Ileo-caecal tuberculosis in immigrants
Authors: Croker J , Record C O , Wright J T
Published: December 2008

Four cases of ileo-caecal tuberculosis in Asian immigrants were seen in a 6-month period at The London Hospital. Although rare in Caucasians, this condition is an important cause of gastrointestinal symptoms in this ethnic group. Definitive diagnosis can frequently be made only by histological examination and culture of biopsy material obtained at laparotomy. However, in suitable cases, where there is a high index of clinical suspicion, a trial of chemotherapy may be preferable to operation. If laparotomy is performed, resection with subsequent chemotherapy is the treatment of choice.
Staphylococcal aortic valve endocarditis with aortic root to right atrial fistula
Authors: De Cock K M , Rees J R
Published: December 2008

Infective endocarditis can be complicated by the development of intra-cardiac shunts. A case of endocarditis secondary to staphylococcal septicaemia is reported where various conduction defects preceded the development of a fistula from the aortic root to the right atrium. Before emergency surgery there was marked worsening of heart failure with the appearance of a new loud murmur throughout diastole.
Intravascular haemolysis and acute renal failure following potassium dichromate poisoning
Authors: Sharma B K , Singhal P C , Chugh K S
Published: December 2008

An 18-year-old girl developed acute renal failure 24 hr after ingestion of potassium dichromate. Laboratory data revealed associated intravascular haemolysis. Renal histology showed features suggestive of acute tubular necrosis. She went into diuretic phase after 11 days of oliguria and subsequently regained normal renal function. Both direct toxic damage by dichromate and intravascular haemolysis may have contributed to the development of acute tubular necrosis and acute renal failure.
Pancreatitis and duodenal obstruction due to periampullary carcinoma associated with familial polyposis coli
Authors: Clarke D N , Smith J A R , Norman J N , Brunt P W
Published: December 2008

Duodenal lesions are being reported in cases with familial polyposis of the colon. A case is described presenting with duodenal obstruction and pancreatitis complicating a peri-ampullary carcinoma in a patient with familial polyposis (adenomatosis of the colon and rectum). Upper gastrointestinal lesions notably in the duodenum include duodenal polyps and carcinoma and peri-ampullary malignancy. It is suggested that endoscopy and hypotonic duodenography be considered in patients with adenomatosis of the colon and rectum presenting with non-colonic alimentary symptoms.
An unusual presentation and complication of acute appendicitis
Authors: Greenway B A
Published: December 2008

A case history is presented to illustrate an uncommon complication of acute appendicitis which itself was overshadowed by an acute arterial embolus.
Immunological results in myocardial diseases
Authors: Bolte H-D , Schultheiss P
Published: December 2008

Immunological studies have shown new diagnostically important changes in alcoholic and viral myocarditis, as well as in congestive cardiomyopathy.

Increased heart size correlated with the degree of congestive heart failure, as well as with negative immunofluorescence and an increased IgA concentration in the serum. These findings may serve as a diagnostic aid in patients with myocardial disease due to alcohol abuse.

Viral heart disease is characterized by a variety of symptoms and nuclear antibodies (IgM) can be of help in the differential diagnosis.

Heart muscle tissue of patients with congestive cardiomyopathy preferentially binds IgG and IgA. In addition to the other changes these findings are of diagnostic importance. It seems likely that results similar to those obtained for humoral antibodies in congestive cardiomyopathy will apply in the correlation of the haemodynamic status of the patients. The pathophysiological implication of these findings is not clear at present, but the evolution of congestive cardiomyopathy appears to be associated with binding of immunoglobulin to the myocardium, as well as with humoral antiheart antibodies.
The management of childhood osteomyelitis
Authors: Khazenifar M , Weighill F J , Stanley J K
Published: December 2008

The management of seventy-six children admitted to Aler Hey Children's Hospital with osteomyelitis is discussed and the indications for surgical intervention are defined. The clinical and pathological course of the disease is examined and the term post-acute osteomyelitis is introduced. The importance of recognition of this stage of the disease and its relevance to the management is highlighted. The use of single antibiotic therapy (clindamycin) is shown to be at least as effective as combinational therapy. Complete resolution was achieved in 94·7% of children, surgical intervention was performed on 74·6%.
Spontaneous mid-oesophageal rupture
Authors: Holt S , Millar J W , Heading R C , Charles R G
Published: December 2008

The clinical presentation and management of spontaneous rupture of the middle third of the oesophagus is described in two patients. Early presentation and treatment in one case led to uncomplicated recovery. In the other patient late presentation and diagnosis resulted in delayed surgical intervention with an unsuccessful outcome. The nature of this rare lesion is discussed and nine previously described cases are reviewed.
Subacute sclerosing panencephalitis
Authors: Bellman M H , Dick G
Published: December 2008

Subacute sclerosing panencephalitis (SSPE) is now considered to be caused by measles virus. There are four diagnostic criteria, namely the clinical picture, a characteristic EEG, serology of serum and CSF and brain histology. A register of cases in the U.K. has been kept since 1971, and up to September 1977, ninety-six patients have been reported. The male/female ratio is 2:1. The disease most commonly affects children between the ages of nine and eleven years who usually have had measles at a very early age. The average delay between the measles infection and onset of SSPE was 6.8 years and of the thirty-four patients known to have died the average survival times was 1.2 years. There are still many questions about the pathogenesis and epidemiology of SSPE that have yet to be answered.
Creutzfeldt—Jakob disease
Authors: Matthews W B
Published: December 2008

The laboratory transmission to animals of an apparently degenerative disease of the nervous system, Creutzfeldt-Jakob disease (CJD), is now well established. Important questions arising from this observation are the possibility of natural transmission or infectivity and the existence of other similarly transmissible diseases. Epidemiological studies have revealed some possible clusters of CJD and also an association with previous craniotomy, but there is no definite evidence of natural infection. A few instances have been reported of experimental CJD in animals following inoculation with material from Alzheimer's disease, but apart from this there is so far no evidence of transmission of any other form of degenerative nervous disease.
A case of multiple endocrine adenomatosis with primary amenorrhoea
Authors: Vandeweghe M , Braxel K , Schutyser J , Vermeulen A
Published: December 2008

A well documented sporadic case of multiple endocrine adenomatosis (MEA) type I, with the pituitary tumour presenting as a prolactinoma, is described in a 28-year-old female. Primary amenorrhoea, resulting from hyperprolactinaemia, was the first symptom of the polyglandular neoplasia. A gastrinoma was removed from the head of the pancreas and latent hyperparathyroidism appeared to be present. Treatment with bromocriptine was poorly tolerated; neurosurgical intervention was refused by the patient. The possibility that a serum prolactin determination may be useful in detecting pituitary involvement in MEA deserves consideration.
Hypocalcaemic cardiac failure
Authors: Brenton D P , Gonzales J , Pollard A B
Published: December 2008

A 35-year-old patient who presented with recurrent chest infection, pulmonary oedema and cardiac failure was found to be grossly hypocalcaemic owing to previously undiagnosed hypoparathyroidism. The cardiac failure was not easily relieved by digoxin and diuretics but it quickly responded when the plasma calcium was restored to normal with dihydrotachysterol. With dihydrotachysterol as sole treatment for more than 2·5 years he had normal exercise tolerance and no features of cardiac failure.
Positive myocardial scintigraphy at the bedside—evaluation using a portable gamma camera
Authors: Dymond D S , Jarritt P H , Britton K E , Langley D , Spurrell R A J
Published: December 2008

A study was undertaken to evaluate the role of positive infarct scintigraphy in the diagnosis of acute myocardial infarction (AMI), using Technetium99m stannous pyrophosphate (Tc-PYP) and a portable gamma camera. Sixty-one patients admitted to the Coronary Care Unit (CCU) with a presumptive diagnosis of AMI or ischaemic cardiac pain were studied. Positive scans were present in 24/25 (96%) patients with AMI and new Q waves, and in 10/12 (83%) patients with AMI and no Q waves. Nine of eleven (82%) patients with chest pain and no infarction had negative scans. Of thirteen patients with unstable angina, ten (77%) had positive scans. A further eight patients undergoing coronary artery bypass surgery for angina pectoris were studied pre- and postoperatively. Two patients had strongly positive postoperative scans. The Tc-PYP scan is valuable in the detection of peri-operative infarction following coronary artery surgery, and in patients with unstable angina the technique may detect small amounts of myocardial necrosis undetectable by more conventional means. When the diagnosis of infarction is obvious from the ECG, enzymes, or a combination of the two, the Tc-PYP scan provides no extra information helpful in patient management.
Response to thyrotrophin-releasing hormone in atrial dysrhythmias
Authors: Symons C , Myers A , Kingstone D , Boss M
Published: December 2008

Seventy-eight clinically euthyroid patients with atrial dysrhythmias, either established or paroxysmal, and sixty-three patients in sinus rhythm with coronary disease were screened for hyperthyroidism using thyroid function tests including the thyroid-stimulating hormone (TSH) response to thyrotrophin-releasing hormone (TRH). All had normal levels of serum thyroxine (T4) apart from three with dysrhythmias who were found to have hyperthyroidism. Twenty per cent of patients with atrial dysrhythmias and 10% of those in sinus rhythm had exaggerated TSH response to TRH. Thirty-six per cent of patients with an exaggerated response of TSH to TRH had significant titres of thyroid auto-antibodies compared with 15% with positive antibodies in those with normal TSH response to TRH. Auto-immune thyroid disease may be more closely related to heart disease than has previously been recognized. Rapid atrial dysrhythmias may occur in the presence of a normal serum thyroxine, high levels of TSH and positive thyroid antibodies.
Immunoblastic lymphadenopathy—report of a case
Authors: Joshi K , Shrinivasa R , Shankar S K
Published: December 2008

A case of immunoblastic lymphadenopathy has been presented which had the characteristic clinical and histological features. The patient did not respond to chemotherapy and succumbed to the disease. Instead of the usual polyclonal gammopathy associated with this condition, he showed a fall in IgM levels, IgG and IgA being within normal limits. The significance of the latter finding is not known.
Tuberculous abscess of the brain
Authors: Mohanty S , Rao C J
Published: December 2008

A bacteriologically confirmed case of tuberculous abscess of the brain is reported. Tuberculous brain abscess unlike tuberculoma does not exhibit the typical granulomatous changes and the diagnosis is confirmed by demonstration of tubercle bacilli either by staining or culture. An antituberculous regime should be started immediately the diagnosis has been established.
Bilateral neuralgic amyotrophy complicating Weil's disease
Authors: Cumming W J K , Thrush D C , Kenward D H
Published: December 2008

The case of a patient with leptospirosis (treated with trimethoprim) with late neurological complications manifesting as a bilateral plexus syndrome is described. The probable reasons for the continued weakness, in this patient, of the muscles supplied by the anterior interosseus nerve, despite improvement in the proximal muscles, are briefly discussed.
A case of Mollaret's meningitis associated with a lymphoma
Authors: Swithinbank I M , Rake M O
Published: December 2008

A patient with recurrent benign meningitis (Mollaret's meningitis) responding to treatment with colchicine by a reduction in frequency of attacks who has subsequently developed a non-Hodgkin's lymphoma is described.
The Budd-Chiari syndrome in pregnancy
Authors: Tiliacos M , Tsantoulas D , Tsoulias A , Kokka E , Eudaimon E , Aphentoglou S , Metzantonakis C
Published: December 2008

A case of Budd-Chiari syndrome in a young woman, which started probably in the last trimester of pregnancy, is described. The diagnosis was made clinically and was confirmed by inferior venacavography and on exploratory laparotomy. The possible connection of the syndrome with the pregnancy is discussed.
Barium granuloma of the transverse colon
Authors: McKee P H , Cameron C H S
Published: December 2008

A case of barium sulphate granuloma of the transverse colon following gunshot wounds to the abdomen has been described. Scanning electron microscopy with electron probe microanalysis was used to confirm the presence of barium sulphate and the absence of lead or other elements related to the gunshot wounds.
Disease due to echovirus type 19 in Birmingham, England, 1975: relationship to ‘epidemic neuromyasthenia’
Authors: Ball A P
Published: December 2008

In the summer of 1975 an extensive epidemic of disease due to echovirus type 19 occurred in the West Midlands. The features of this outbreak, and their relationship to the syndrome referred to as ‘epidemic neuromyasthenia’, are discussed. The two diseases are considered to be separate entities.
Parathyroid carcinoma presenting as hyperosmolar coma
Authors: Peters J R , Thomas J P
Published: December 2008

A case of hyperosmolar coma is described in a patient with maturity onset diabetes, who was subsequently shown to have a parathyroid carcinoma. The pathogenesis of the hyperosmolar state is discussed.
The psychiatric Münchausen
Authors: Ben-Tovim David I
Published: December 2008

Two cases of patients with the Münchausen syndrome who sought admission for fictitious psychiatric illnesses are presented - one case involves an accomplice. The patients' authentic life histories are used in the discussion of the syndrome's aetiological factors.
Cursive and gelastic epilepsy: probable sequelae of physical abuse
Authors: Woon T H , Vignaendra V
Published: December 2008

An abandoned 8-year-old male child, who was subjected to physical abuse, presented with abnormal behaviour and focal seizures. The focal seizures included involuntary running attacks (epilepsia cursiva) and uncontrollable laughter (gelastic epilepsy). The occurrence of cursive and gelastic seizures in the same patient is extremely rare. These fits were probably a late sequel of head trauma.
Pyoderma gangrenosum associated with acute myeloproliferative disease (? erythroleukaemia)
Authors: Toolis Francis , Parker Alistair C , Barnetson Ross
Published: December 2008

Pyoderma gangrenosum at the site of sternal marrow aspirate was observed in a patient with acute myeloproliferative disease characterized by a high peripheral blood basophilia. Lesions with a similar appearance were also seen on the palate. No other disease known to be associated with pyoderma gangrenosum could be demonstrated. A review of the literature suggests that myeloproliferative disease should now be recognized as occurring in association with pyoderma gangrenosum.
Erythro-myeloid aplasia following D-penicillamine treatment in primary biliary cirrhosis
Authors: Jones S , Corringham R E T , Jain Stephan
Published: December 2008

A woman with primary biliary cirrhosis and a high liver copper concentration was treated with D-penicillamine as a participant in a controlled trial of the drug. After 14 weeks she developed a Pseudomonas septicaemia and was found to have erythro-myeloid aplasia. Similar, but not identical blood dyscrasias have previously been reported as complications of D-penicillamine therapy. She survived after treatment with antibiotics and granulocyte transfusions, and bone marrow function returned to normal.
Radiation diarrhoea and cholestyramine
Authors: Condon John R , Wolverson Richard L , South Marie , Brinkley Diana
Published: December 2008

Radiation diarrhoea was treated successfully with cholestyramine, and this is confirmed by faecal biochemistry. The reasons for this response are discussed and it is suggested that the resin may affect gut bacterial activity.
Fatal retroperitoneal haemorrhage complicating anticoagulant therapy
Authors: Lowe G D O , McKillop J H , Prentice A G
Published: December 2008

Eight cases are reported of extensive retroperitoneal haemorrhage in patients receiving anticoagulant therapy who subsequently died and underwent postmortem examination. No patient had an obvious source of bleeding, and in 5 cases no other cause for death was apparent. Three patients had had vascular surgical procedures: the other 5 were given anticoagulants for suspected venous thrombo-embolism. Six cases presented as unexpected circulatory collapse with rapid demise. Four patients had in addition gastro-intestinal bleeding of varying degree, with no obvious source. This acute massive type of retroperitoneal bleeding contrasts with the commoner presentations of pain, swelling, bruising and compression neuropathy: a high index of suspicion and urgent treatment are required if mortality is to be reduced.
Leiomyoma of the duodenum presenting as a pyogenic liver abscess
Authors: Selvam A , Donaldson L J , Sokhi G S
Published: December 2008

Leiomyoma of the duodenum is a rare condition which is most often diagnosed only as an incidental finding at post-mortem. It may present clinically with pain or haemorrhage. A case is described of degeneration of a leiomyoma of the fourth part of the duodenum giving rise to pyogenic liver abscess. There is no previous report of this association in the literature.
Adult pre-sacral teratoma
Authors: Graham D F , McKenzie W E
Published: December 2008

The clinical details and management of an adult female patient with a pre-sacral teratoma causing obstructed labour are described.
Approaches towards rational antiviral chemotherapy
Authors: Oxford J S
Published: December 2008

Present epidemic influenza is uncontrolled by immuno- or chemoprophylaxis. Mutants of varying antigenic composition arise with relatively high frequency in nature and are able to circumvent herd, or induced, immunity. Also, drug-resistant viruses can be selected in vitro and this resistance can be exchanged to other viruses by gene reassortment. Combined immuno- and chemoprophylaxis may provide a more effective approach to the ultimate control of the disease. Most antiviral compounds have been selected by random screening in the laboratory. Application of more specific enzyme assays such as the virion-associated RNA transcriptase assays may produce other compounds with a defined mode of action - semi-rational chemotherapy. RNA and polypeptide sequence studies are in progress elsewhere to define transcription and translation initiation sites or virus adsorption sites. Such knowledge could lead to a new generation of antiviral compounds. Specific delivery of virus inhibitory compounds is an interesting problem. Liposomes are lipid spheres, and these have been used for the delivery of antiviral compounds.
The influenza virus: Antigenic composition and immune response
Authors: Schild G C
Published: December 2008

The architecture and chemical composition of the influenza virus particle is described with particular reference to the protein constituents and their genetic control. The dominant role in infection of the surface proteins - haemagglutinins and neuraminidases - acting as antigens and undergoing variation in time known as antigenic drift and shift is explained. The immuno-diffusion technique has illuminated the interrelationships of the haemagglutinins of influenza A viruses recovered over long periods of time. The H0 and H1 haemagglutinins are now regarded as a single sub-type with H2 and H3 representing the haemagglutinins of the 1957 and 1968 sub-types. Animal influenza viruses of pigs, horses and birds are described. A relation to human influenza strains has been shown to exist in certain instances as is the capacity of some human strains to pass to the animal kingdom.
Ventricular fibrillation following high potency intravenous vitamin injection
Authors: Falk R H , Protheroe D E
Published: December 2008

A 67-year-old woman developed ventricular fibrillation following Parenterovite injection. Subsequent post-mortem revealed normal coronary arteries. It is postulated that the high potency vitamin injection caused the arrhythmia.
Cytomegalovirus-associated gastric ulcer simulating malignancy
Authors: Cullen M H , Stansfeld A G
Published: December 2008

A case is reported of cytomegalovirus (CMV) infection with radiological, gastroscopic and histological appearances which led to a mistaken diagnosis of carcinoma of the stomach.
Chronic ulcerative jejunitis without symptoms
Authors: Kane S P , Parkins R A
Published: December 2008

A patient is presented who, in addition to subtotal villous atrophy, had superficial ulcers of the jejunum, as well as a wide band of granulation tissue deep to the crypts suggesting recurrent past ulceration. In spite of these changes she had no intestinal symptoms at the time of her presentation with reflux oesophagitis, and her only nutritional abnormality was a mild folate deficiency. Withdrawal of dietary gluten produced some improvement of the jejunal mucosa but this was not sustained on continued low-grade ingestion. She has containued to be virtually symptom-free over a 3-year period of follow-up.
Heterogeneity of failure of visual acuity in Graves' disease
Authors: Sachdev Y , Chatterji J C , Sharma R C
Published: December 2008

The eye manifestations of Graves' disease are usually mild and self-limiting. Occasionally they follow a progressive course leading to visual loss and total blindness. The ocular manifestations bear no relationship to the metabolic state and may appear before, during or after onset of thyrotoxicosis. Characteristically they become evident at about the time of onset of hypermetabolism. Various factors responsible for the failure of visual acuity are discussed with case illustrations.
The clinical pathology of heart failure and atrial fibrillation in old age
Authors: Hodkinson H M , Pomerance A
Published: December 2008

The factors associated with the development of heart failure and of atrial fibrillation in elderly patients were studied in a prospective clinico-pathological series of 171 cases. Multiple logistic analyses allowed the contributions of multiple factors to be assessed simultaneously.

Senile cardiac amyloidosis, ischaemic heart disease and atrial fibrillation were significantly associated with heart failure and had additive effects. Senile cardiac amyloidosis, ischaemic heart disease, mitral valve ballooning and higher age were significantly associated with atrial fibrillation but their additive effects were modified by significant interactions between ischaemic heart disease and mitral valve ballooning (whose effects were multiplicative) and senile cardiac amyloidosis and age (the age effect being confined to those without amyloidosis).
The incidence of postoperative pulmonary perfusion defects
Authors: Griffiths N J , Wighton R J , Festenstein J B
Published: December 2008

The incidence of postoperative thromboembolism was studied using radioisotope lung perfusion and ventilation scanning. 26% of patients had defects on their pre-operative scans and 8% developed new unmatched perfusion defects postoperatively, indicating possible pulmonary emboli. This latter figure was much lower than some previously recorded results and was similar in 2 groups of patients—one receiving dextran 70 prophylaxis during operation and the other a control group who received saline.
Hip fracture after hemiplegia
Authors: Mulley G , Espley A J
Published: December 2008

In a series of 57 hemiplegic patients who subsequently fractured their hips, it was found that hip fracture occurred significantly more often on the hemiplegic side. Hip fracture was equally common in right- and left-sided hemiplegia, and often occurred within one year of the stroke.

Two factors seem to be important in the genesis of hip fractures in hemiplegic patients: the tendency of stroke patients to fall to the affected side as a result of impaired locomotor function, and the development of disuse osteoporosis in the hemiplegic limb.
Levamisole in the treatment of cyclical neutropenia
Authors: Proctor S J , Reid M M , Low W T
Published: December 2008

A child with cyclical neutropenia was observed before and during treatment with levamisole. Marked clinical improvement occurred while on levamisole. Deterioration occurred after stopping treatment. The improvement was not associated with changes in the neutrophil or monocyte counts, nor did tests of phagocytic cell function convincingly demonstrate improvement while the child was on treatment.
Renal disease in pregnancy
Authors: Evans D B
Published: December 2008

In this review the need for early antenatal assessment of renal disease is stressed as is the need to follow-up all patients in the puerperium in whom renal dysfunction has been suspected during pregnancy. A variety of renal disorders and their effect on the outcome of pregnancy are discussed.
The physiology of thyroid function in pregnancy
Authors: Feely J
Published: December 2008

Pregnancy has a variety of effects on maternal thyroid function. Thyroid gland enlargement is common particularly in areas of relative iodine deficiency. The renal clearance of iodine is increased in pregnancy and together with an increased volume of iodine distribution, leads to a low plasma inorganic iodine and thus increases the thyroidal iodine clearance. However, the absolute iodine uptake and hormone production rate remain unchanged.

There is an increase in the serum thyroxine (T4)and triiodothyronine (T3) concentration largely due to an increase in thyroid hormone-binding proteins. Free thyroxine and free T3 remain unchanged in pregnancy as does the Free Thyroxine Index, which gives the single most accurate measure of thyroid function. The placenta secretes a number of thyroid stimulators including human chorionic gonadotrophin and possibly chorionic thyrotrophin and molar thyrotrophin whose physiological role is to date poorly understood.

The fetal thyroid develops independently, and although fetal T4 Concentration Rises PROGRESSIVELY To maternal by term, the T3 concentration is markedly reduced owing to preferential formation of inactive reverse T3.
The management of thyroid disease in pregnancy
Authors: Edwards O M
Published: December 2008

The management of hyperthyroidism and hypothyroidism in pregnancy is discussed and illustrated with appropriate cases. The dangers of the usage of high doses of antithyroid drugs and of propranolol are described.
Clinical aspects of diabetes in pregnancy
Authors: Robinson R E
Published: December 2008

The introduction of insulin produced a rapid improvement in the maternal prognosis in pregnancy associated with diabetes mellitus. Within years, maternal mortality fell from 50% and has become a rarity. Improvement in fetal survival was less dramatic until the work of Pedersen (1952); Peel and Oakley (1950) and White (1949) demonstrated that with determined antenatal control of diabetes the fetal outcome was greatly improved. Further improvement in the care of the fetus of the pregnant diabetic with fetal monitoring, both ante- and intra-partum, together with modern neonatal expertise, had brought the perinatal and neonatal morbidity and mortality for this group of patients close to that of the non-diabetic. An account is given of the author's present day practice in this group of patients.