bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigation of a case of prednisolone malabsorption
Authors: Mant T G K
Published: December 2008

Malabsorption of prednisolone administered as enteric coated tablets was suspected following therapeutic failure in an asthmatic. This was investigated by cortisol estimation and a Synacthen test and substantiated by the demonstration of abnormally low absorption of prednisolone from these tablets which nevertheless were normally absorbed by a volunteer. The absorption of prednisolone from conventional tablets in this patient was normal.
Severe acute mountain sickness
Authors: Dickinson J G
Published: December 2008

The experiences of acute mountain sickness (AMS) as it has presented to a physician working in a general hospital at 1370 m in Kathmandu, nepal, are described. The features of 39 cases are analysed. It is suggested that AMS should be classified into benign and malignant forms.
Birmingham Medical Research Expeditionary Society 1977 Expedition: signs and symptoms
Authors: Fletcher R F
Published: December 2008

The BMRES group of 17 persons is described and details are given of the trek to 5400 m. The research programme is outlined. Moderately severe acute mountain sickness (AMS) was observed in 5 subjects. All subjects were rated according to their symptoms related to AMS by interview, peer review and self-assessment, and the results compared.
Terminal care: evaluation of in-patient service at St Christopher's Hospice. Part I. Views of surviving spouse on effects of the service on the patient
Authors: Parkes C M
Published: December 2008

The surviving spouses of 34 patients who died of cancer at St Christopher's Hospice have been interviewed about 13 months after the patient's death. The information given is compared with that obtained from 34 spouses of patients dying from cancer in other hospitals and matched with the St Christopher's group.

Patients at St Christopher's were less often thought to have suffered severe pain and other distress than at other hospitals, but pain relief was not bought at the cost of drug-induced confusion and patients at St Christopher's remained more mobile than at other hospitals.

Hospice patients were more aware of chapel services and prayers than at other hospitals. None was said to have been upset by these and 66% were glad of them.

Despite the frequency of deaths in the Hospice, patients at St Christopher's were no more likely to be thought to have been 'upset' by such events than patients elsewhere or to have found their interactions with other patients anything but helpful.
The problem of tricyclic antidepressant poisoning
Authors: Crome P , Newman B
Published: December 2008

In the year May 1976 to April 1977, 489 enquiries about the management of tricyclic antidepressant poisoning received at the London Centre of the National Poisons Information Service were followed-up. One hundred and sixty-four patients (33.5%) were unconscious, convulsions occurred in 62 (12.7%), hypotension in 31 (6.3%), respiratory depression in 28 (5.7%), tachydysrhythmias in 17 (3.5%) and cardiac arrest in 12 patients (2.5%). Sixteen patients died (3.3%). No statistically significant differences were found between individual antidepressants although poisoning with amitriptyline-like drugs resulted in a significantly higher proportion of unconscious patients than poisoning with imipramine-like drugs (P < 0.01). There were more asymptomatic children than adults and more unconscious adults than children. Tricyclic antidepressant poisoning is a major clinical problem in general medical and paediatric practice.
Propranolol in acute intermittent porphyria
Authors: Menawat A S , Panwar R B , Kochar D K , Joshi C K
Published: December 2008

Twenty cases of acute intermittent porphyria were studied during the acute phase. Cardiovascular manifestations were noted in all the cases, with tachycardia in 20 and with hypertension in 17. Propranolol in doses ranging from 20–200 mg was given to all the cases and produced adequate control of tachycardia and hypertension. At follow-up, smaller doses of propranolol were found to maintain the pulse rate and BP within normal limits and also to prevent acute attacks.
Head nodding in arteriopathic dementia—a new kind of tic?
Authors: Ryan D A , Warrington S J
Published: December 2008

An elderly woman with arteriopathic dementia developed a bizarre and repetitive nodding movement of the head. This is believed to be an unusual form of tic.
Hypocalcaemic chorea secondary to malabsorption
Authors: Howdle P D , Bone I , Losowsky M S
Published: December 2008

A patient presented with chorea and a recent history of Crohn's disease. Investigation revealed the cause of the chorea to be hypocalcaemia secondary to malabsorption. So far as is known there has been no previous report of hypocalcaemic chorea due to malabsorption.
Gastric leiomyoma and leiomyosarcoma—five cases
Authors: Lee F I
Published: December 2008

Five patients with smooth muscle tumours of the stomach are presented. In 3 cases, histological identification of the lesion was made pre-operatively on biopsy material obtained under direct vision at gastroscopy.
Recognition and chemotherapy of oculomycosis
Authors: Jones Barrie R , Clayton Yvonne M , Oji Erasmus O
Published: December 2008

Oculomycosis may be divided into the orbital infections of phycomycosis of Aspergillus and other species and the infections of the globe. The latter comprise endogenous, post-surgical or traumatic intra-ocular infections and direct infections of the cornea: these are the commonest form of oculomycosis. They are not easy to differentiate from other, more common causes of septic infection of the eye. The early recognition of fungal infections of the eye thus rests on maintaining an efficient service for all septic infections of the eye.

Candida albicans and other dimorphic fungal infections are best treated with flucytosine combined with either polyenes such as amphotericin B and natamycin or combined with imidazoles such as clotrimazole or miconazole.

Aspergillus spp. account for about 50% of the cases of filamentous fungal infection of the cornea but more than 100 species of varying pathogenicity and drug sensitivity have been implicated. Econazole, clotrimazole or miconazole combined with thiabendazole are recommended for Aspergillus spp. Econazole, thiabendazole or miconazole combined with flucytosine for Cladosporium sp. For Fusarium solani and other species econazole is the best drug but some isolates are sensitive to thiabendazole or other imidazoles.

Alternatively, filamentous fungal infections may be treated with natamycin which has a broad spectrum of activity; but does not penetrate well and, like other polyenes, should not be combined with imidazole antifungal chemotherapy because of antagonistic drug interaction.

Overall, econazole emerges as the most widely acting drug; but successful results are dependent on rather complex investigation with intensive and protracted care that can best be provided in a few centres of referral.
Fungal endocarditis: patients at risk and their treatment
Authors: Seelig M S , Goldberg P , Kozinn P J , Berger A R
Published: December 2008

Fungal endocarditis is not rare. It usually develops in patients with abnormal or surgically traumatized hearts, to whose blood fungi have gained access, perhaps during temporary (often iatrogenic) impairment of host defences. Although the blood is cleared rapidly, the fungus can establish itself in the endocardium, where it grows slowly. Thus, clinical and laboratory procedures (including blood and urine cultures) that have permitted early diagnosis and treatment of bacterial endocarditis, are not reliable in early fungal endocarditis. Greater reliance must be placed on serological monitoring of patients who have had transient fungaemia and are at risk of endocarditis. The clinician must consider factors that enhance fungal proliferation and invasion and be cognizant of its dangers - even in the absence of clear signs of infection. Prophylactic measures should be employed to protect the patient at risk, including topical, oral and systemic use of appropriate antifungal agents. Early therapy, the extent and duration of which can be determined by (1) obtaining the MIC of transitory blood or urine isolates - which should not be ignored - and (2) monitoring serology, might eliminate early invaders of the endocardium. Sixty-four reported cures of fungal endocarditis caused by Candida, the most common fungal pathogen, are tabulated, 29 were of classic fungal endocarditis requiring surgery, 3 of whom were seen later by others as fatal recurrences. Those treated early (shortly after candidaemia was diagnosed - mostly in patients on treatment for bacterial endocarditis or after cardiac surgery) survived without need for surgical removal of vegetations or valve replacement. Despite strong suggestive evidence that the first 35 patients tabulated had fungal endocarditis, histological proof exists for only a few who had surgery.

Cures of endocarditis caused by other fungi are noted. Improved surgical and medical therapy has improved the prognosis even of patients with the far-advanced disease. However, development of classic fungal endocarditis has been reported one or more years after cardiac surgery and late recurrences after intensive therapy of fungal endocarditis, that had led to clinical recovery of 2 years or more, have been reported. Serological monitoring of vulnerable patients might alert the physician to recurrence early enough for efficacy of drug therapy, averting fatal outcome or the need for further surgery.
Candida vaginitis
Authors: Hurley Rosalinde , de Louvois John
Published: December 2008

The pathogenesis incidence and epidemiology of Candida vaginitis is considered.
Pharmacokinetics of imidazole antimycotics
Authors: Plempel M
Published: December 2008

According to data on the imidazole antimycotics at present on the market, none of these products satisfactorily fills the gaps which exist in the treatment for mycoses of internal organs, although they have brought considerable progress in the topical treatment of mycoses.

On the basis of their very broad spectrum and high intensity of activity under suitable test conditions, and the comparatively tolerable amount of side effects in man, the present imidazole antimycotics are considered to be an encouraging start for future development of derivatives which will lead to products with considerably better pharmacokinetic, and therefore better therapeutic, properties.
Pharmacokinetics of amphotericin B and flucytosine
Authors: Polak A
Published: December 2008

The absorption of flucytosine from the digestive tract is very good but minimal with amphotericin B. For this reason, amphotericin B has to be injected intravenously. Fungistatic levels are achieved rapidly with flucytosine and slowly with amphotericin B, since the dose has to be increased slowly. Distribution of flucytosine in other body fluids is high, whereas with amphotericin B it is poor. Flucytosine is excreted mainly via the kidney without metabolism, whereas amphotericin B is eliminated mainly by metabolism. Therefore, amphotericin B dosage does not have to be adapted to kidney function, which is the case for flucytosine. The half-life of flucytosine is short (hours), that of amphotericin B is long (days); flucytosine is haemodialysable, whereas amphotericin B, probably owing to the high protein binding, is not.
Modern aspects of testing azole antifungals
Authors: Haller I
Published: December 2008

Difficulties in the in vitro testing of azole antimycotics are described. The value of minimal inhibitory concentration results are discussed and contrasted to those obtained with polyene antimycotics.
In vitro synergy and antagonism of antifungal agents against yeast-like fungi
Authors: Dupont B , Drouhet E
Published: December 2008

Some antifungal agents have been tested qualitatively in various associations against species of Candida, Cryptococcus and Torulopsis. The method used was the channel test and the results are confirmed by comparison with the serial dilution test in agar.

The antagonism in vitro with the combination of amphotericin B imidazole suggests that caution must be exercised before prescribing the antifungal drugs in combination for man. The frequent synergy of flucytosine with econazole is, however, encouraging because of the low toxicity of the 2 drugs. Under the limited conditions described, the combination of flucytosine and amphotericin B was not found synergistic but additive on the strains of C. albicans used in this study. This combination was found synergistic for a strain of C. parapsilosis and is useful for avoiding resistance to flucytosine.
A review of the Zollinger-Ellison syndrome – with particular reference to a patient treated with cimetidine
Authors: Wyke R J , Hill G L , Axon A T R
Published: December 2008

A case of the Zollinger-Ellison syndrome, presented with watery diarrhoea, malabsorption and multiple duodenal ulcers. Resection of a gastrinoma from the head of the pancreas was ineffective. Cimetidine, administered for more than 30 months produced an immediate and sustained relief of symptoms with a gain in weight of 19 kg and improvement of the biochemical features of malabsorption. Gastric acid secretion has been markedly inhibited and duodenal ulceration healed.
An insulinoma presenting with reactive hypoglycaemia
Authors: Connor H , Scarpello J H B
Published: December 2008

A 57-year-old woman presented with symptoms which were cured by the removal of an insulinoma. The case was atypical in that symptomatic hypoglycaemia occurred only after meals or glucose administration but never during fasting, and thus if plasma insulin activity had not been measured an incorrect diagnosis of reactive hypoglycaemia might have been made on the basis of symptoms and oral glucose-tolerance test. Reactive hypoglycaemia resulted from an increased rate of glucose assimilation and possibly also from a decreased rate of gluconeogenesis due to the immense insulin secretion provoked by glucose or food.

The findings suggest that a diagnosis of hypoglycaemia should not be made until the possibility of an insulinoma has been excluded by measurement of plasma insulin activity during a period of hypoglycaemia.
Combined rifampicin and chloramphenicol therapy for Enterobacter osteomyelitis
Authors: Naveh Y , Friedman A
Published: December 2008

A 2-month-old infant with Enterobacter osteomyelitis complicating total parenteral nutrition was successfully treated with rifampicin and chloramphenicol. No untoward side effects attributed to rifampicin has been noted despite prolonged administration of rifampicin.
The existence of inflammatory bowel lesions in gluten-sensitive enteropathy
Authors: Kumar P J , O'Donoghue D P , Gibson J , Stansfeld A , Dawson A M
Published: December 2008

Three patients with coincident coeliac disease and inflammatory bowel disease are described. In 2 patients with known coeliac disease the recurrence of diarrhoea was not due to dietary deviation but to an additional large bowel pathology.
Pneumatosis cystoides intestinalis secondary to chronic jejunal diverticulitis
Authors: Sammon A M , Malcolm A J
Published: December 2008

Pneumoperitoneum due to pneumatosis cystoides intentinalis is reported in a patient with congenital jejunal diverticula. Attention is drawn to the potential diagnostic problems in patients with known intestinal pathology who present with pneumoperitoneum.
Rifampicin-induced thrombocytopenia
Authors: Hadfield J W
Published: December 2008

Rifampicin occasionally causes thrombocytopenia when given as part of an intermittent regimen. A case is reported of severe thrombocytopenia developing after one dose of rifampicin, following a 4-month gap in daily therapy. The literature on rifampicin-induced thrombocytopenia is reviewed.
Bacterial pyomyositis in a patient with aplastic anaemia
Authors: Mitsuyasu R , Gale R P
Published: December 2008

Bacterial pyomyositis is common in the tropids but is rare in temperate climates. A patient with aplastic anaemia who had never left the continental United States developed bacterial pyomyositis secondary to Staphylococcus aureus which responded to antibiotics and surgical drainage. Bacterial pyomyositis should be considered in the differential diagnosis of fever and myalgias in the immunocompromised patient.
Mesenteric panniculitis
Authors: Ormiston M C , Thomson H
Published: December 2008

A case of mesenteric panniculitis is presented, with a review of previous reports.
Baclofen overdose
Authors: Lipscomb D J , Meredith T J
Published: December 2008

A 57-year-old woman suffering from multiple sclerosis took an estimated 1500 mg of baclofen. She became deeply unconscious with generalized flaccid muscle paralysis and absent tendon reflexes. Toxicological analysis confirmed the presence of baclofen together with small amounts of paracetamol and glutethimide. Supportive therapy, including assisted ventilation for 3 days, led to complete recovery; anticonvulsant drugs were necessary for the treatment of grand mal fits. The clinical features and treatment of baclofen overdose are discussed.
Brucella endocarditis on double valvular prosthesis
Authors: Lezaun R , Teruel J , Maître M J , Artaza M
Published: December 2008

The case is reported of a 48-year-old man suffering from Brucella endocarditis on a double prosthesis. The successful medical and surgical treatment is described. So far as the authors know, this is the first report of Brucella endocarditis from a heart valve prosthesis.
A possible association of partial lipodystrophy with anti-GBM nephritis (Goodpasture’s syndrome)
Authors: Blake D R , Rashid H , McHugh M , Morley A R
Published: December 2008

Partial lipodystrophy is known to be associated with mesangiocapillary glomerulonephritis. A case is described of a possible association of partial lipodystrophy with anti-GBM nephritis (Goodpasture’s syndrome).
Salivary theophylline estimation in the management of asthma in children
Authors: Lena S M , Hutchins P , Wood C B S , Turner P
Published: December 2008

Simultaneous sampling was performed to determine whether saliva could replace plasma in the monitoring of theophylline dosages. Forty-eight children with moderate to severe asthma received oral theophylline preparation (usually sustained release) on a daily basis. They provided simultaneous saliva and plasma samples at routine out-patient visits. Saliva and plasma theophylline concentrations showed a wide variation between individuals, and their ratios also differed. Saliva theophylline concentrations below 7 micrograms/ml reflect plasma concentrations below 10 micrograms/ml, i.e. sub-therapeutic, while saliva concentrations above 7 micrograms/ml are consistent with therapeutic dosage.

Estimation of saliva theophylline concentration on routine visits avoids the discomfort of blood sampling. It reflects whether daily oral theophylline dosage in childhood asthma is below or within the therapeutic range. The need for changes in dosage and the degree of patient-compliance with therapy can be usefully indicated.
Diffuse involvement of the leptomeninges by tumour--a clinical and pathological study of 63 cases
Authors: Boyle R , Thomas M , Adams J H
Published: December 2008

The clinical and pathological features of 63 cases of post-mortem-proved diffuse infiltration of the leptomeninges by tumour are presented. A wide variety of tumours of the nervous system, both primary and secondary, was found to give rise to such involvement, with adenocarcinoma having a particular propensity to behave in this manner. Dysfunction of cranial and spinal nerves, a confusional state and headache were prominent clinical features. Examination of the cerebro-spinal fluid was found to be less useful diagnostically in cases of primary tumours of the nervous system with leptomeningeal involvement than in cases of diffuse infiltration of the meninges by carcinoma.
Mixed connective tissue disease with associated glomerulonephritis and hypocomplementaemia
Authors: Palferman T G , McIntosh C S , Kershaw M
Published: December 2008

Mixed connective tissue disease is an increasingly recognized entity in which renal disease is thought to be unusual and associated hypocomplementaemia even more uncommon. A patient is described who had both these features and who also illustrates many of the characteristic features of this syndrome. The response to steroids of the systemic sclerosis component is well shown and an additional feature of interest is the family history of other connective tissue diseases.
Behçet’s syndrome: unusual multisystem involvement and immune complexes
Authors: Hyman N M , Sagar H J
Published: December 2008

A case of-Behçet’s syndrome is described in which, in addition to the usual features of the condition, there was evidence of renal, gastric and cardiac involvement. Neurological involvement presented as hemisphere, transient ischaemic episodes. Immune complexes were detected and the patient responded promptly to prednisolone.
Campylobacter enteritis presenting as an acute abdomen
Authors: Hay D J , Ganguli L A
Published: December 2008

A case is reported of a young patient with Campylobacter enteritis who underwent first appendicectomy and then a laparotomy because of the severity of the pain and the marked abdominal signs.
Volume expansion and vasodilators in the treatment of idiopathic postural hypotension
Authors: Jones D H , Reid J L
Published: December 2008

A case is cited in which hydrallazine was used in conjunction with volume expansion as a novel approach to the improvement of orthostatic symptoms in a patient with idiopathic postural hypotension.
Hyperkalaemic paralysis due to spironolactone
Authors: Udezue E O , Harrold B P
Published: December 2008

A case is reported of an adult who presented with hyperkalaemic muscular paralysis induced by spironolactone.
Successful management of serious disopyramide poisoning
Authors: Holt D W , Helliwell M , O’Keeffe B , Hayler A M , Marshall C B , Cook G
Published: December 2008

A case of deliberate disopyramide overdosage is described. Circulatory collapse was treated by means of a large dose of isoprenaline, and charcoal haemoperfusion was used in an attempt to enhance the elimination of disopyramide. The suitability of this treatment regime is discussed in the light of findings from animal studies and the implications for the management of the disopyramide-poisoned patient are considered.
Eosinophilic leukaemia in association with a double Philadelphia chromosome
Authors: Stockdill G , Hartley S E , Allan N C
Published: December 2008

A case of eosinophilic leukaemia in association with chromosomal abnormalities including a double Philadelphia chromosome is reported. Comment is also made on the cardiological problems which arise in this condition.
Xanthogranulomatous pyelonephritis presenting with unilateral renal vein thrombosis
Authors: Akintewe T A , Dealler S , Hutcheon A W
Published: December 2008

Haematuria in an elderly patient is a common urological complaint. A patient is described in whom xanthogranulomatous pyelonephritis presented as unilateral renal vein thrombosis. So far as the author is aware, this is the first report of such an association.
The diagnosis and management of hyperparathyroidism during pregnancy
Authors: Deutsch A A , Zager M , Bernheim J , Steiner Z , Reiss R
Published: December 2008

Hyperparathyroidism during pregnancy is rare and very few cases have undergone parathyroidectomy during the course of gestation. In reviewing the literature it is apparent that surgery during the second trimester should be the treatment of choice. The complication rate of untreated cases may reach 80% and include spontaneous abortion, fetal death and neonatal tetany. The paper is illustrated with appropriate cases.
Severe barbiturate and paracetamol overdose: the simultaneous removal of both poisons by haemoperfusion
Authors: Helliwell M
Published: December 2008

Charcoal haemoperfusion was successful in the treatment of severe butobarbitone poisoning complicated by resistant hypotension. At the same time the rapid removal of paracetamol may have lessened the severity of the subsequent hepatic injury. The mechanism and management of shock associated with barbiturate poisoning, and the possible application of haemoperfusion in paracetamol poisoning are discussed.
Gall-bladder polyps in Peutz-Jeghers syndrome
Authors: Foster D R , Foster D B E
Published: December 2008

A case of Peutz-Jeghers syndrome with polyps in the gall bladder is presented. No previous description of this finding has been reported. The literature regarding known sites of polyposis in this condition is reviewed.
Aortic regurgitation and false aortic aneurysm formation in Behçet’s disease
Authors: Rae S A , Vandenburg M , Scholtz C L
Published: December 2008

Behçet’s disease is associated with vascular complications. Aortic regurgitation associated with this condition has never previously been described. A case is now reported in which this occurred and which was followed postoperatively by a false aneurysm of the ascending aorta.
Cimetidine and renal failure
Authors: Seidelin R
Published: December 2008

A patient is described who developed reversible renal failure while taking cimetidine.
Mucinous adenocarcinoma of the renal pelvis
Authors: Joshi K , Jain K , Mathur S , Mehrotra G C
Published: December 2008

A case of mucinous adenocarcinoma of the renal pelvis occurring in association with staghorn calculus and severe pyelonephritis is reported. The incidence and aetiopathogenesis of this neoplasm is briefly discussed.
Paracetamol
Authors: Meredith T J , Goulding R
Published: December 2008

Paracetamol is an analgesic and antipyretic agent which was first marketed for use as a drug in the U.K. in 1956. It has since become popular with the medical profession and the general public as an alternative to aspirin.
Comparative effect of cimetidine and ranitidine on prolactin secretion
Authors: Nelis G F , Van de Meene J G
Published: December 2008

Cimetidine has been shown to stimulate prolactin secretion after a intravenous administration. Cimetidine 200 mg and ranitidine 50 mg was given i.v. in a randomly allocated order to 22 volunteers on consecutive days; these doses can be regarded as equivalent as far as inhibition of gastric acid output is concerned. Plasma prolactin was estimated at regular intervals. The prolactin stimulating effect of cimetidine was confirmed while ranitidine did not influence plasma prolactin levels. Although cimetidine and ranitidine seem to be equally effective in reducing gastric acid output, the effect of the drugs are not the same on their entire spectrum of action since ranitidine does not influence plasma prolactin. It still has to be established in clinical trials which drug is the best choice in clinical medicine.
Growth hormone, prolactin and thyrotrophin responses to thyrotrophin-releasing hormone in diabetic patients
Authors: Harrower A D
Published: December 2008

Growth hormone (GH), prolactin (PRL) and thyrotrophin (TSH) responses to thyrotrophin-releasing hormone (TRH) were studied in 15 insulin-dependent diabetic patients. Basal plasma GH levels were raised above 5 mu./l in 6 patients and following the injection of TRH there was a significant rise in plasma GH levels in 9. The mean rise in plasma GH from basal to peak values was significant in the group as a whole (P < 0.01).

Basal PRL and TSH levels were normal and rose normally in response to TRH.

GH release may be qualitatively abnormal in some diabetics and any such loss of specificity of GH-releasing mechanisms would further contribute to the raised GH levels found in many diabetics which would be of importance if GH is a factor in the aetiology of diabetic microangiopathy.
West Indian amblyopia
Authors: Fasler J J , Rose F C
Published: December 2008

A series of 21 patients admitted to St Thomas’ Hospital, Medical Ophthalmology Unit, with a diagnosis of West Indian or West African amblyopia is reported. Patients were investigated for haematological, biochemical, serological, and radiological abnormalities and particular attention was paid to dietary history. Patients admitted in recent years also underwent neurophysiological investigations. No definite correlation between visual loss and dietary or family history was found, and there was no evidence that the improvement in vision which occurred in just under half the patients on follow-up was related to treatment with hydroxocobalamin or multivitamins. Visual-evoked responses in 4 patients showed a prolonged latency suggesting optic nerve demyelination, while in only one case was the electro-oculogram definitely subnormal. These findings contrast with those in ‘toxic’ amblyopias and suggest that the syndrome of West Indian amblyopoa may be due to bilateral optic nerve demyelination of unknown aetiology rather than the effect of toxic substances or nutritional deficiency on the retina.
Acute epiglottitis in an adult
Authors: Barman S N , Bell H , Chazan B I
Published: December 2008

A 33-year old man developed acute epiglottitis of sudden onset which resulted in severe respiratory distress. A small endotracheal tube was passed as an emergency procedure. Respiratory arrest developed after he pulled it out 12 hr later. Subsequent progress was satisfactory following endotracheal intubation and treatment with ampicillin and hydrocortisone. Blood cultures grew Haemophilus influenzae.
Myelopathy during treatment for pulmonary tuberculosis
Authors: Reid A C , Bone I
Published: December 2008

A patient who developed a myelopathy during a course of treatment for pulmonary tuberculosis is described. The underlying mechanisms and problems in diagnosis are discussed.
Chronic eosinophilic pneumonia complicating long-standing rheumatoid arthritis
Authors: Payne C R , Connellan S J
Published: December 2008

A 54-year-old patient with long-standing rheumatoid arthritis developed chronic eosinophilic pneumonia in association with a relapse of his arthritic condition. There was a rapid and complete response to oral steroid therapy.
Coronary heart disease. The size and nature of the problem
Authors: Turner R W
Published: December 2008

In the U.K., coronary heart disease has reached epidemic proportions. It is the commonest cause of death after the age of 35 years and the fastest rate of increase is in early middle age. The epidemic is due mainly to our way of life. The most important factors are dietary, with smoking, physical inactivity and stress also contributing. Twenty independent working parties from different countries have reviewed the dietary evidence and reached a strong consensus on dietary recommendations. Little action has been taken in the U.K. The Coronary Prevention Group has been formed to consider the reasons for this inaction and also the implication for research, the government, the Ministry of Agriculture, Fisheries and Food, the Department of Health and Social Security, the food and agriculture industries, caterers, nutrition education and for individuals, of the dietary recommendations.
Prevention of coronary heart disease: the role of essential fatty acids
Authors: Sinclair H M
Published: December 2008

There are 2 classes of essential fatty acids (EFA), the linoleic (n-6) and linolenic (n-3). They are required for the glycerophosphatides (phospholipids) of cellular membranes; the transport and oxidation of cholesterol; the formation of prostaglandins. In deficiency of EFA, cellular membranes are imperfectly formed which causes increased susceptibility to various insults and increased permeability. Low-density lipoproteins (LDL) transport cholesterol mainly as cholesteryl linoleate and supply EFA to tissue. A relative deficiency of EFA (i.e. a high ratio in the body of non-EFA such as long-chain saturated fatty acids to EFA) causes an increase in plasma cholesterol. EFAs cause decreased aggregation of platelets. Atherosclerosis is not caused by increased aggregation of platelets, and can be prevalent in a population in which coronary thrombosis is rare.
Dietary prevention at home and abroad
Authors: Shaper A G
Published: December 2008

The main dietary recommendations towards the prevention/postponement of coronary heart disease (CHD) made in the U.K. in the last decade are reviewed. There is substantial agreement regarding the need for a reduction in the intake of saturated fats. It is suggested that only moderate changes in dietary polyunsaturated: saturated ratio may be sufficient to achieve changes in the incidence of CHD.
Control of hypertension in out-patients. Experience of the Glasgow Blood Pressure Clinic
Authors: Johnston J H , Lorimer A R , Rodger J C , Robertson W K , Thomas A , Lawrence W , Fife R
Published: December 2008

Five hundred and sixty-two patients who had attended the Glasgow Blood Pressure Clinic regularly for 3 years between 1969 and 1978 were studied. The mean BPs for the group were 187/115 mmHg initially, 157/100 mmHg after 6 months, and 153/98 mmHg after 3 years. Twenty-eight per cent had ‘normal’ systolic pressure and 22% ‘normal’ diastolic pressure at 3 years. Thirty-seven per cent with mild, 83% with moderate, and 89% with severe systolic pressure elevation had moved into less severe categories by 3 years, as had 30% with mild, 60% with moderate and 84% with severe diastolic evaluation. Those patients with severe hypertension, who did not attain a less grade, had a statistically significant drop in pressure. Four per cent of all patients, however, had moved into a more severe severe grade of systolic pressure evaluation and 6% into a more more severe diastolic pressure grade at 3 years. These results suggest that the hospital Hypertension Clinic can play a useful part in the lowering of BP in out-patients. It is clear, however, that ‘normal’ BP levels are not achieved in a significant proportion of patients.
Recurrent spontaneous hypothermia
Authors: Slotki I N , Oelbaum M H
Published: December 2008

A patient with recurrent attacks of hypothermia is presented. Despite intensive investigation, no other manifestation of hypothalamic or autonomic dysfunction has been found. Treatment of concurrent biochemical hypothyroidism has not altered the frequency or severity of the hypothermic attacks.
Portuguese-type amyloid neuropathy in an English family
Authors: Mahood J M
Published: December 2008

A 31-year-old woman thought to be suffering from a psychiatric illness was found to have peripheral and autonomic neuropathy, keratoconjunctivitis sicca and vitreous opacities. Her mother had died 10 years previously, aged 42 years from an undiagnosed illness with similar features. Histological proof of amyloidosis was obtained in both cases. This is the second report of familial amyloid neuropathy in an English family.
Acute renal failure complicating Legionnaires’ disease
Authors: Harvey M , Quirke P , Warren D
Published: December 2008

A 45-year-old man developed symptoms of pneumonia while on holiday in Spain. On his return home, a diagnosis of Legionnaires’ disease was confirmed, complicated by acute renal failure, He was treated with dialysis and spontaneous recovery of renal function began on day 19.
Terminal care: evaluation of an advisory domiciliary service at St Christopher’s Hospice
Authors: Parkes C M
Published: December 2008

In a matched, comparative study the provision of an advisory service to families who were nursing a patient with incurable cancer at home enabled the patient to stay at home longer than he otherwise would and helped the family and primary care team to cope with the added burden which resulted. Families seem to have been well satisfied with the help which was given and there were considerable savings in cost to the health service.
Plasma and salivary concentrations of erythromycin after administration of three different formulations
Authors: Henry J , Turner P , Garland M , Esmieu F
Published: December 2008

In a 6-volunteer cross-over study the pharmacokinetics of 3 erythromycin preparations were compared. A single oral dose of 500 mg of each preparation was administered at each occasion and the levels measured in timed samples of plasma and saliva. Markedly higher blood concentrations of the estolate and propionate were obtained compared to the stearate. Comparison of serum and plasma concentration of the drugs from each split sample showed no significant differences. Plasma concentrations always exceeded those in saliva but for any one preparation a similar ratio was obtained at different times. This may be useful to ascertain compliance and to measure concentration of the compounds where direct measurement in plasma is not practicable.
Low-dose vincristine in the treatment of corticosteroid-refractory idiopathic thrombocytopenic purpura (ITP) in non-splenectomized patients
Authors: Cervantes F , Montserrat E , Rozman C , Diumenjo C , Feliu E , Grañena A
Published: December 2008

Eight non-splenectomized patients with corticosteroid-refractory idiopathic thrombocytopenic purpura (ITP) were treated with low-dose vincristine (1 mg/week up to a total dose of 4 mg). Complete remission was achieved in 2 cases and partial remission in 3. Bleeding stopped in one patient who failed to remit. No statistical relationship was found between the response to vincristine and the duration of the disease or the corticosteroid-therapy. Side effects were only observed in one patient. By comparing these results with those reported in the literature, it can be inferred that low-dose vincristine may be useful in the management of corticosteroid-refractory ITP.
Retroperitoneal fibrosis and scleroderma
Authors: Mansell M A , Watts R W E
Published: December 2008

The association of retroperitoneal fibrosis and systemic sclerosis is reported from a patient positive for the HLA-B27 antigen. This appears to be the first report of such an association. Pathological features common to the 2 syndromes are discussed and the literature is reviewed.
Azathioprine in chronic relapsing idiopathic polyneuropathy
Authors: Pentland B
Published: December 2008

A 33-year-old housewife with a 14-year history of relapsing polyneuropathy of unknown cause who has apparently responded to azathioprine therapy is described. The place of this form of treatment in idiopathic polyneuropathy is discussed.
Hypocalcaemia increases the narcotic effect of codeine
Authors: Levine D F
Published: December 2008

Severe narcosis occurred in a patient with hypoparathyroidism given therapeutic doses of codeine phosphate.
Hyperemesis gravidarum due to thyrotoxicosis
Authors: Valentine B H , Jones C , Tyack A J
Published: December 2008

A case of hyperemesis gravidarum at 9 weeks’ gestation is described for which no cause could initially be found. Intravenous feeding was needed as a life preserving measure and following improvement on this regime the patient went into a thyrotoxic crisis which was successfully diagnosed and treated. The continuing pregnancy and its outcome is described. The need for practitioners to remember vomiting as a presenting sign of thyrotoxicosis is stressed.
Problems in home monitoring of blood glucose
Authors: Pantin C F , Bihari D , Brown E A , Bloom A
Published: December 2008

Two hundred and forty blood glucose readings were made on 5 Glucochek machines by 2 different operators. The results on all machines correlated poorly with equivalent results from an automatic glucose analyser with major discrepancies at all glucose concentrations. There was a wide gap in performance between the 2 operators. Analysis of variance suggested that errors were not only due to inter-operator and inter-machine differences. Possible sources of error were shown to include time of reaction and the amount of blood on Dextrostix. Dextrostix colour changes measured by eye were as accurate as those by Glucochek without the rogue values found at higher glucose concentrations with Glucochek.
Peyronie’s disease in a district general hospital
Authors: Odiase V O , Whitaker R H
Published: December 2008

Peyronie’s disease can cause severe physical and psychological distress. Of 31 cases in this retrospective study, 12 underwent spontaneous improvement in their symptoms which makes the assessment of active treatment in other patients difficult. The indications and limitations of operative approach are discussed.
Sarcoidosis and chronic sensory neuropathy
Authors: Payne C R , Tait D , Batten J C
Published: December 2008

A patient with long-standing sensory peripheral neuropathy is described who finally presented with acute pulmonary sarcoidosis after a period of 18 years. Purely sensory neuropathy presumably due to sarcoidosis of this duration has not been reported before.
Steroid-responsive vasculitis and arthritis in meningococcal septicaemia
Authors: Keeling P W N , Aston N O , Croft D N
Published: December 2008

The case of a 42-year-old West Indian woman with meningococcal septicaemia and steroid-responsive immune complex disease is reported.
Measurement of the effects of a single dose of prazosin on the cerebral blood flow in hypertensive patients
Authors: Rutland M D , Lee T Y , Nimmon C C , Granowska M , Britton K E
Published: December 2008

It was considered that the first dose reaction occurring with prazosin may have been due either to hypotension or to a specific reduction in cerebral blood flow. The development of a quantitative non-invasion nuclear medicine technique for cerebral flow has now made it possible to investigate the effects of prazosin on cerebral blood flow in hypertensive patients. This double-blind study showed a significant decrease in BP and a small just significant increase in cerebral blood flow following a single 1-mg dose of prazosin, when compared with a placebo. From these results, it is unlikely that the first dose reactions which occurred with prazosin were due to a specific reduction in cerebral blood flow.
Mucus-secreting ‘signet-ring’ cells in CSF revealing the site of primary cancer
Authors: Agnelli G , Gresele P
Published: December 2008

A case is reported of leptomeningeal carcinomatosis in which identification of mucus-secreting ‘signet-ring’ carcinoma cells in the CSF allowed diagnosis of an otherwise asymptomatic gastric cancer. When lumbar puncture is performed, careful cytological examination of the CSF should be carried out in any undiagnosed patient with neurological symptoms and signs.
Dual primary adenocarcinoma of the duodenum and jejunum in a patient with previous colonic cancers
Authors: Swift A C , Smith G T , Douglas D L
Published: December 2008

Primary adenocarcinoma of the small intestine is an uncommon tumour, the incidence being 40-60 times less frequent than carcinoma of the colon. Multiple primary neoplasia of the small bowel, although not infrequently seen with benign growths, is an extremely rare event with malignant lesions. A patient is described who had an adenocarcinoma of the duodenum and jejunum, with a previous history of colonic carcinomas. The case is discussed together with a brief review of the literature.
Streptococcal pharyngitis--rapid diagnosis by Gram stain
Authors: Sharma S C , Subbukrishnan P V
Published: December 2008

Group A beta-haemolytic streptococci were isolated from 51 (9.8%) of 519 patients with pharyngitis. Throat culture results showed the mean sensitivity, specificity and predictive value of a positive Gram-stained smear of pharyngeal secretions as 70%, 89% and 69%. The data suggest that Gram staining of a smear directly from the swab is as accurate as and more speedy than a culture from the pharyngeal secretion for diagnosis of streptococcal pharyngitis.
Long-term treatment of trigeminal neuralgia with carbamazepine
Authors: Taylor J C , Brauer S , Espir M L E
Published: December 2008

The results of treating 143 patients with trigeminal neuralgia with carbamazepine (CBZ) over a 16-year period have been reviewed. The drug was effective initially with few mild side effects in 99 patients (69%). Of these, 19 developed resistance later, i.e. between 2 months and 10 years after commencing treatment, and required alternative measures. Of the remaining 80 (56%), the drug was effective in 49 for 1-4 years and in 31 for 5-16 years. Thirty-six patients (25%) failed to respond to CBZ initially and required alternative measures, as did 8 (6%) who were intolerant of the drug. One patient developed CBZ-induced water intoxication with hyponatraemia. Subsequently hyponatraemia was excluded in 17 patients who had been taking CBZ for between 4 months and 7 years. This study has thus confirmed the efficacy of CBZ in the treatment of trigeminal neuralgia and shown that it may continue to be effective for many years.
Treatment of adult lymphoblastic leukaemia using cyclical chemotherapy with three combinations of four drugs (COAP, POMP, TRAP schedule)
Authors: Proctor S J , Finney R , Walker W , Thompson R B
Published: December 2008

Seventeen adult patients with previously untreated acute lymphoblastic leukaemia (ALL) were entered into a schedule of chemotherapy in which 3 combinations, each of 4 drugs, were administered in a predetermined cyclical rotation in combination with cranial irradiation and intrathecal injections of methotrexate. Of the 17 patients, 16 completed induction therapy and 15 (94%) entered remission. The only patient with T-ALL died before receiving any therapy. The median survival for all patients (17) was 22 months. Meningeal leukaemia did not occur during the haematological remission phase although 3 patients developed this complication following relapse. The authors conclude that the addition of cyclophosphamide and cytosine arabinoside to vincristine/prednisone provides excellent remission induction but the aggressive maintenance schedule employed has not led to significant long-term survival.
Audit of an inner city coronary unit
Authors: Pedoe H T , Besterman E , Kidner P H
Published: December 2008

The performance of the St Mary’s Hospital London W2 coronary care unit was studied in each of 2 years, 1969 and 1975, results of which could be compared with each other and with national figures from the annual reports of the Hospital In-patient Enquiry. In 1975 the admissions were 42% more than in 1969; the increase was confined to mild cases over 45 years of age, and was out of proportion to national trends. The hospital fatality rate was unchanged and when age-standardized was 69% and 78% of contemporaneous national rates. In both years, 50% of the patients admitted came from outside the health district and 10% of local admissions were visitors from abroad. In 1975 there was an increased proportion of ex-smokers among the patients and more gave a history of previous myocardial infarction. The value and limitations of this kind of surveillance of a clinical unit are argued.
Bronchial carcinoma and hyperkeratosis palmaris et plantaris
Authors: Powell F , Mackey J P
Published: December 2008

A 44-year-old man who presented with recent onset hyperkeratosis palmaris et plantaris was found to have a carcinoma of the bronchus.
Arthropathy in Dressler’s syndrome
Authors: Davidson C
Published: December 2008

Three patients developed a polyarthritis in association with Dressler’s (post-myocardial infarction) syndrome. Joint involvement was more pronounced in the upper limbs and persisted many months after other features of Dressler’s syndrome had settled. In 2 cases the findings in the joints were slight and might have been overlooked but for the persistently raised ESR. There was a prompt symptomatic response to prednisone.
Hyperlipidaemia diagnosed at lumbar puncture
Authors: Burke B J , McKee J I , Hargreaves T
Published: December 2008

A patient presenting with subarachnoid haemorrhage and high lipid concentrations in the cerebrospinal fluid (taken at lumbar puncture), who has later shown to have type V hyperlipidaemia is described. This case, so far as can be ascertained by the authors, is the first report of hyperlipidaemia being diagnosed from CSF examination.
Effects of captopril (SQ 14,225) in a patient with primary pulmonary hypertension
Authors: Horowitz J D , Brennan J B , Oliver L E , Harding D , Goble A J , Louis W J
Published: December 2008

In a 33-year-old patient with severe primary pulmonary hypertension, the acute administration of the angiotensin-converting-enzyme inhibitor captopril (SQ 14,225) induced a rise in cardiac output, and a fall in both pulmonary and systemic vascular resistance. Subsequent chronic oral administration of captopril induced only transient clinical improvement, and the patient died. Captopril may nevertheless be useful in the treatment of less advanced cases of this disease.