bluuebunny/crossref_metadata_2025 huggingface dataset:
A review of the present position of Australia antigen
Authors: MacCallum F O
Published: December 2008

The nature of Australian antigen, its site of replication and its probable nature are discussed.

The influence of genetic factors in the incidence of hepatitis associated with Australia antigen or its carriage is reviewed.
Prevention of hepatitis with immunoglobulin
Authors: Reid Daniel
Published: December 2008

Immunoglobulin appears to be effective in preventing the clinical features of infectious hepatitis among contacts of the disease provided it is given before the later stages of the incubation period. A single dose of 750 mg gives protection for a period of up to 7 months.

The evidence of the value of immunoglobulin for contacts of serum hepatitis is conflicting.
Hepatitis and activity
Authors: Krikler Dennis M
Published: December 2008

The effects of physical activity during an attack of infectious hepatitis are discussed.

There is no evidence that activity during convalescence produces any ill-effects.

On the other hand, strenuous physical activity in the acute stage may be dangerous, possibly because hepatic blood-flow is reduced.
Haemodialysis-associated hepatitis
Authors: Finn Ronald
Published: December 2008

Outbreaks of hepatitis have occurred in renal units all over Europe and the U.S.A. and have carried a high mortality.

This is an iatrogenic disease, transmitted by blood from carriers of SH virus, uraemic patients often suffering subclinical attacks.

The risks to the staff of these units are so high that they should not be asked to undertake this work if outbreaks cannot be controlled.
Sexual inadequacy in the male
Authors: Bancroft John
Published: December 2008

The adequacy of sexual functioning in the male depends on a complex interaction between psychological, hormonal and neurophysiological factors. Disturbance of any one of these factors may lead to sexual inadequacy. In the majority of cases no gross abnormality is found but the absence of gross hormonal or neurophysiological abnormality does not necessarily imply a purely psychological cause. Individual variations in the pattern of response of the autonomic nervous system or in the ability to learn control of autonomic responses such as erection or ejaculation may be sufficient to account for some cases of inadequacy and in others may increase the susceptibility to psychological factors. Further research is required to clarify these undoubtedly important psychophysiological relationships.

Treatment has been most successful when it has taken into account both psychological and physiological factors. The advances made by Masters & Johnson (1970) in this area have partly depended on their earlier physiological and anatomical studies of sexual response (Masters & Johnson, 1966).

It may be that in some cases the use of anxiety-reducing drugs or androgens will be all that is required but further work is required to identify such cases. The placebo effects of such preparations should not be overlooked particularly as many cases of sexual inadequacy are based on lack of confidence or ignorance and require little more than good advice or reassurance.

Considerable advances in our understanding of these problems have been made in the past 20 years and techniques of endocrine, physiological and behavioural assessment are now available which should enable further progress to be made in the near future.
The insulin response to glucose in patients with non-diabetic glycosuria
Authors: McKiddie M T , Scott R T A , Cole R
Published: December 2008

Glucose tolerance tests (GTT) were performed and plasma insulin levels measured by immunoassay in eighty-nine subjects previously found to have non-diabetic glycosuria (fifty-six with renal glycosuria and thirty-three with lag curves). The time-interval between the two tests varied from 6 months to 13 years.

Ten patients had developed chemical diabetes but only three had symptoms. Two had initially renal glycosuria and eight lag curves. This significantly different incidence may have been due to an excess of older patients in the lag-curve group.

The mean insulin response was higher in those with diabetes than in those in whom the second test was normal. The individual insulin responses were abnormal by our criteria in twenty-six subjects including six of the ten diabetics. In twenty-four subjects plasma insulin levels had been measured during the initial GTT. The insulin response had been abnormal in thirteen of these, four of whom were diabetic at follow up. In contrast only one of the eleven subjects with an initially normal insulin response had developed diabetes.

It is suggested that an abnormal insulin response to glucose may be an indication of potential diabetes.
Fructose in medicine
Authors: Huttunen Jussi K
Published: December 2008

A review is given of the metabolism of fructose in the mammalian organism, and its significance in medicine. Emphasis is laid upon the absorption and assimilation of fructose through pathways not identical with those of glucose. The metabolism of fructose is largely insulin-independent, although the ultimate fate of fructose carbons is determined by the presence or the absence of insulin.

Clinical and experimental work has suggested that fructose may exert beneficial effects as a component of the diet for patients with mild and well-balanced diabetes. Fructose is absorbed slowly from the gut, and does not induce drastic changes in blood sugar levels. Secondly, fructose is metabolized by insulin-independent pathways in the liver, intestinal wall, kidney and adipose tissue.

As a consequence of the rapid and efficient utilization of fructose, it has been used widely for intravenous feeding in medicine and surgery. However, it has been shown that the rapid infusion of large amounts of fruetose may cause accumulation of lactic acid in the extracellular fluid. The possibility of lactate acidosis, with concomitant impairment of the acid-base balance, already disturbed, constitutes a relative contraindication to the use of intravenous fructose in the treatment of diabetic ketoacidosis.

Fructose is known to accelerate ethanol metabolism in the liver. No well-documented reports on the use of fructose in the treatment of ethanol intoxication have been published, although it has recently been suggested that fructose might be of value in the treatment of delirium tremens.

Fructose may be less cariogenic than sucrose, at least in short-term experiments. Long-term trials are lacking, and thus the potential advantages of fructose in preventive odontology have not been determined.

Fructose does not seem to have any side-effects when used in reasonable amounts. However, it has been reported that the administration of fructose in large amounts induces hyperlipidemia both in man and in experimental animals. Earlier suggestions concerned with the atherogenic properties of fructose have recently been challenged. The apparent increase in the incidence of coronary disease among sucrose users seems to be a statistical artefact, caused by the increased ingestion of coffee and soft drinks by cigarette smokers.
Urinary tuberculosis
Authors: Riddle P R
Published: December 2008

The present incidence, clinical features and classification of urinary tuberculosis are discussed.

Chemotherapy is the mainstay of treatment. The indications for surgical intervention are reviewed and procedures briefly described.
Spinal tuberculosis
Authors: Jackson J W
Published: December 2008

Seventy-one out of eighty-four cases of spinal infection operated on at the Royal National Orthopaedic Hospital in the last 12 years were due to tuberculosis.

The clinical features are reviewed.
Future policy for BCG vaccination in Britain
Authors: Sutherland Ian
Published: December 2008

The reduction in tuberculosis to be expected from mass BCG vaccination in Britain during the next few years has been assessed. It is concluded that mass BCG vaccination in adolescence should very soon be replaced by a selective vaccination policy aimed at groups at particular risk of exposure to tubercle bacilli.
Tuberculosis in England and Wales in the next 20 years
Authors: Bignall J R
Published: December 2008

Present trends in the incidence of tuberculosis are reviewed.

Extrapolation suggests that there will only be about 1200 notifications in 1980. By 1990 it is probable that the disease will be no commoner than non-tuberculous meningitis is now, and by 2010 it should be of interest to the medical historian only.
The hypoglycaemic action of metformin
Authors: Frayn K N , Adnitt P I , Turner Paul
Published: December 2008

Twenty-four-hour excretion of D-xylose after oral administration in nine diabetic patients, and of 3-0-methyl-D-glucose in six patients, showed no significant change after treatment with metformin. There was, however, a significant reduction in mean fasting blood glucose levels in thirteen patients from 160 to 115 mg/100 ml (P <0·001), and the intravenous glucose tolerance improved in twelve of these patients (P <0·01), during treatment with metformin.

It is concluded that the hypoglycaemic action of metformin does not depend primarily on an intestinal effect.
The early diagnosis of lung cancer
Authors: Deeley T J
Published: December 2008

Earlier diagnosis of malignant disease in the lung may bring about improvements in the treatment. This article discusses the effects of early diagnosis on the prognosis. Cancer of the lung may be associated with other lung pathology, thus increasing the problems of diagnosis. Diagnosis depends on radiological examination, cytology of the sputum, radio-isotope lung scanning and mediastinoscopy: an account is given of how these may be used to diagnose the condition whilst it is still at an early stage and suitable for radical treatment.
Methoxyflurane analgesia for burns dressings
Authors: Packer Kathleen J
Published: December 2008

The requirements for analgesia for burns dressings are discussed.

Methoxyflurane has proved satisfactory in a clinical trial, and can be administered by one of two types of vaporizer.

The possibility of nephrotoxicity due to methoxyflurane has not been eliminated.
The value of brain scanning
Authors: Riddoch D , Drolc Z
Published: December 2008

Over a 3-year period, 667 brain scans were performed, of which the results in 632 have been analysed.

Positive scans were found in 68% of 204 cerebral tumours. There was a high rate of detection of meningiomas and malignant gliomas. Scanning was less helpful in visualizing slowly growing gliomas, and those tumours situated in the mid-line or posterior fossa. Metastases occupied an intermediate position.

Positive scans occurred in a proportion of patients following acute cerebro-vascular accidents, and in a few other miscellaneous disorders.

Virtually all patients with transient cerebral ischaemia, migraine, epilepsy and presenile dementia had normal brain scans.

The value and limitations of this investigation have been discussed.
Infection associated with modern surgical procedures
Authors: Shaw D
Published: December 2008

In postoperative wound infections due to Escherichia coli, 59% of the sepsis was caused by ten O-serotypes. For each serotype, except O6, the frequency of sepsis mirrors the frequency of carriage. Endogenous wound infection: evidence was presented but not discussed. Eleven patients had wound infections due to serotype O6, five were carriers of this serotype at the time of operation. Serotype O6 occurred significantly more frequently in wounds than in carriage specimens. In this study the strains showed enhanced infectivity in wounds.
Assessment of electrical conversion of supraventricular arrhythmiasPresented at Symposium of the Royal College of Physicians of Ireland and the American College of Physicians in Dublin, Eire, on 18 September, 1971.
Authors: Kernohan R J
Published: December 2008

Direct current shock therapy in 244 cases of atrial fibrillation, fifty cases of paroxysmal supraventricular tachycardia, and eighteen cases of atrial flutter has been assessed. The administration of intravenous diazepam (Valium) allowed direct current shock therapy without general anaesthesia and tracheal intubation.

Seventy percent of cases of atrial fibrillation, 96% of cases of paroxysmal supraventricular tachycardia, and 94% of cases of atrial flutter reverted to sinus rhythm. The 190 patients first treated were followed up after the attempt at conversion until relapse of the arrhythmia or for a minimum of 2 years. The best results were obtained in arrhythmia of thyrotoxic aetiology. In patients with ischaemic/hypertensive heart disease and rheumatic heart disease the results were disappointing.

The success rate with direct current shock therapy is inversely related to the cardiothoracic index, and with increase in heart size there is also deterioration in the long-term results. Only one of the patients who had a cardiothoracic index of more than 55% remained in sinus rhythm at the end of 2 years.

The success rate decreases with increasing duration of the preceding arrhythmia, particularly when it had been present for more than 1 year, and the stability of the attained sinus rhythm also decreases with increasing duration of the preceding arrhythmia.

Direct current shock therapy is the method of choice in most cases of atrial flutter. Direct current shock therapy is seldom indicated in paroxysmal supraventricular tachycardia except in cases with underlying serious heart disease. Direct current shock therapy is contra-indicated in digitalis-induced arrhythmias.
The effect of fenfluramine on glucose tolerance, insulin, lipid and lipoprotein levels in patients with peripheral arterial disease
Authors: Bliss B P , Kirk C J C , Newall R G
Published: December 2008

An investigation has been undertaken to determine the effects of fenfluramine on glucose tolerance, insulin, fasting lipid and lipoprotein levels, in a series of twenty-five patients suffering from peripheral arterial disease.

The results indicate that fenfluramine significantly improved glucose tolerance and that this was not the result of increased insulin production. Small but significant reduction in fasting cholesterol and β lipoprotein levels also occurred in most of the patients. Fenfluramine had no consistent effect on fasting nonesterified fatty acid, glycerides or pre-β lipoproteins.
The pharmacokinetics of an oral form of carbenicillin in patients with renal failure
Authors: Bailey R R , Eastwood J B , Vaughan R B
Published: December 2008

An orally active ester of carbenicillin was administered to patients with varying degrees of renal dysfunction. The peak serum levels and serum half-life were found to be increased in patients with renal failure. Urine levels, however, in these patients were above the minimum inhibitory concentration for the majority of urinary tract pathogens.
Hyperfunctioning carcinoma of the parathyroid gland
Authors: Gale T C , Owens C W I
Published: December 2008

Carcinoma of the parathyroid gland is rare, constituting about 1% of most series of patients with hyperparathyroidism. In 1969 a collective review identified forty-six unequivocal cases, and since then a further seven cases have been described in the literature.

A brief review of the condition is presented, and one further case of hyperfunctioning adenocarcinoma of the parathyroid gland is reported in detail. Primary treatment is discussed, together with postoperative biochemical problems, and the therapeutic manoeuvres available to deal with recurrences are presented.
Diagnosis of listerial infections in infants
Authors: Harper I A , Howells C H L
Published: December 2008

Five cases of suspected listerial infection are presented; four were proved to be genuine. Problems arose in the microscopy of smears of cerebrospinal fluid; the organism was not detected in one case, and in two other cases it was described as another type of bacterium. Difficulties in identifying the organism culturally are also discussed.
Coeliac disease and small bowel carcinoma
Authors: Kenwright Simon
Published: December 2008

Small bowel carcinoma can occur in association with villous atrophy in the jejunum. In most reported cases there is doubt as to which of these represents the primary lesion. These cases are reviewed here. A further case is reported in which a carcinoma developed in a patient known to be suffering from coeliac disease for some years, although he was not on a gluten-free diet for the time preceding the diagnosis of carcinoma. On dietary restriction he remains well at 2-year follow-up. Possible aetiological factors are discussed.
Maternal bronchial carcinoma and its possible relation to neonatal hypoglycaemia
Authors: Sharp J C , Carty M J , Logan R W
Published: December 2008

A neonate whose mother had been diagnosed as suffering from bronchial carcinoma presented with many of the features characterizing the syndrome shown by babies of diabetic mothers. It is suggested that over-production of corticotrophin in the mother was responsible for the hypoglycaemia and other manifestations in the infant.
Hypoglossal nerve palsy complicating a case of infectious mononucleosis
Authors: Sibert J R
Published: December 2008

A case of infectious mononucleosis complicated by the rare neurological complication of left isolated hypoglossal nerve palsy is described. The literature on cranial nerve palsies in infectious mononucleosis is briefly reviewed.
Platelet adhesiveness in gout
Authors: Darlington L Gail , Scott J T , Shaw Sidney
Published: December 2008

Platelet adhesiveness studies were performed by two techniques in twenty-two gout patients and closely matched controls under carefully standardized conditions. No significant difference in platelet adhesiveness was found between the groups.
Metastatic endophthalmitis: a rare complication of meningococcal meningitis
Authors: Haider S
Published: December 2008

A bacteriologically proved case of meningococcal meningitis developed metastatic endophthalmitis, a rare complication of this disease and responded satisfactorily to antibiotic therapy with complete recovery.
Clostridial brain abscess and hyperbaric oxygen
Authors: Keogh A J
Published: December 2008

The first case of ‘gas gangrene’ of the brain treated with hyperbaric oxygen is reported. It is suggested that there is no place in clostridial infection confined to the central nervous system for hyperbaric oxygen treatment. The early onset of symptoms in clostridial brain abscess with the presence of a gas bubble localizing the abscess were again confirmed. The importance of taking a careful history and obtaining skull radiographs in suspected penetrating wounds is stressed.
Inactivated vaccines. 1. Volunteer studies with very high doses of influenza vaccine purified by zonal ultracentrifugationPresented by the senior author before the symposium on Influenza Vaccines, London, 27 April 1972.
Authors: Mostow Steven R , Schoenbaum Stephen C , Dowdle Walter R , Coleman Marion T , Kaye Harold S
Published: December 2008

In these studies very high doses (up to 4800 CCA units in adults) of formalin inactivated influenza vaccine purified by density gradient centrifugation were given safely to more than 5000 volunteers drawn from adolescent, middle aged and elderly populations. The relative paucity of reactions, compared with those groups receiving much lower doses of formalin-inactivated vaccine produced by Sharples centrifugation, suggests that reactions are due to non-viral substances rather than to toxic properties of the viruses, and that these substances are removable.

Homologous serum HI antibody responses increased with increasing vaccine dosage and there was no plateau effect at the higher dose level. In those groups studied, the appearance of neutralizing activity in post-vaccination nasal washings correlated closely with the higher vaccine doses and higher HI antibody titres.

The occurrence of the ‘Hong Kong flu’ epidemic in two of the groups, including over 3000 vaccine recipients, provided a unique opportunity to study the efficacy of the various vaccines used. Only those groups receiving high doses of a Hong Kong-like antigen (A2/Aichi/2/68) enjoyed significant reduction in illness (70%). Furthermore, there was a 90% reduction in the incidence of fever in that group.

These results indicate that very large doses of purified influenza vaccine can be given safely. Significant prevention and modification of disease caused by influenza via the vaccine approach is dependent on the administration of large doses of the appropriate antigen.
Studies on influenza vaccine in industry
Authors: Smith J W G , Pollard R
Published: December 2008

Large scale studies of influenza vaccination in industry have recently been started. The studies are of two types: (a)Vaccination was offered to a factory and a record maintained of sickness absence of all employees, both the vaccinated volunteers and the non-volunteers. In five different factories, the average acceptance rate was 42%.An analysis of the volunteers in one factory indicated that acceptance of vaccination was highest in middle-aged married women and low in younger and older men.(b)In the Post Office telecommunications branch vaccination was offered to 26,317 employees in eighty-eight units in different parts of the country; 42% of these accepted vaccination. Ninety-eight other units, employing 25,202 employees, are acting as unvaccinated controls. Sickness absence is being recorded in both groups of units.

In both these groups of studies it is aimed to compare the absence experience of the immunized and non-immunized groups for a prolonged period, both when influenza is and is not occurring.

Preliminary findings are presented of the absence figures for January and February 1972, during which time a mild outbreak of influenza occurred, with only a small effect on sickness absence. Vaccinated persons in factories had lower absence rates than the non-vaccinated persons, and telecommunications units in which vaccination was offered experienced lower absence rates with less respiratory absence.

The significance of these findings is discussed.
The protective effect of intranasal immunization with inactivated influenza virus vaccine
Authors: Liem K S , Jacobs J , Marcus E A , van Strik R
Published: December 2008

Protection against influenza after killed influenza spray vaccine was assessed in nine double blind, placebocontrolled clinical trials and two field studies, involving a total number of 10,000 subjects.

Monovalent vaccine, containing 300–360 IU A/Hong Kong/1/68 (H3N2) or bivalent vaccine, containing 300–360 IU A/Aichi/2/68 (H3N2) and 200–240 IU B/Mass/3/66 per dose was used.

Administration by the intranasal route appeared to be acceptable as an alternative to the parenteral route. The protective efficacy found was comparable with that attained after parenteral vaccination. It has, however, the advantages of a characteristic lack of side-effects and of the fact that no injection is involved. This will probably enhance the acceptance of influenza immunization by the population and thus lead to a higher vaccination rate in the communities we want to protect against influenza.
A new subunit influenza vaccine: acceptability compared with standard vaccines and antigenicity in increasing dosageTaken from an article originally published in the Journal of Infectious Diseases (1972) 125, 656.
Authors: Ruben Frederick L , Jackson George Gee
Published: December 2008

Subunit influenza vaccines have the advantage of purity and a broad dosage range. Clinical studies were done with a new subunit vaccine produced by detergent fractionation with tri-(n-butyl) phosphate (TNBP). Acceptability by the recipients was compared in volunteers given 400 CCA units of A2 and 300 of B Influenza vaccine as either Sharples, zonal centrifuged, ether subunit, or TNBP subunit bivalent vaccines. When given subcutaneously, subunit vaccine caused only slightly less pain and erythema induration than zonal or Sharples vaccine. Compared with the i.m. route, the same vaccine given subcutaneously produced twice the local pain and eight times the erythema induration. Fever was infrequent and low grade by either route. HI antibody rises were good in all groups. Increasing dosages of TNBP vaccine up to 6400 CCA units of A2 and 4800 of B given i.m. as monovalent vaccine, produced no local and few febrile responses. An augmentation of the antibody titre occurred with the highest CCA unit dosages. Subunit vaccine given i.m. permitted administration of high CCA unit dosage beyond that accepted for standard vaccine without any increase in local reactions and with a measurable increase in antibody production and the induction of antibodies against related heterologous strains.
Tumours of the sigmoid colon following ureterosigmoidostomy
Authors: Lien W M
Published: December 2008

A case of bilateral adenomatous polyps and a case of adenocarcinoma of the sigmoid colon following ureterosigmoidostomy are described. The recent literature is reviewed. The possible causes and the mucosal changes of the large bowel after ureterosigmoidostomy are briefly discussed.
A neonatal complication of maternal leukaemia treated with 6-mercaptopurine
Authors: McConnell J B , Bhoola R
Published: December 2008

A 24-year-old African mother, who had received 6-mercaptopurine for acute leukaemia from before conception and throughout her pregnancy is described. The child, born prematurely, was anaemic at birth, with many features of a micro-angiopathic haemolytic anaemia. It is suggested that the mother's disease or treatment was involved in the aetiology of this anaemia.
The patient with angina; symptoms and disability
Authors: Mayou Richard
Published: December 2008

Cardiac and mental states were assessed for forty men with angina pectoris, and relatives were interviewed as to symptoms and social disability.

Depression and anxiety together with irritability, fatigue and sleeplessness were common and minimization of such symptoms as well as of physical limitation was prominent. There were characteristic and major changes at work and in leisure and family life.

Disability was not closely related to physical handicap and it was evident that personality factors are of considerable significance in determining response and adaptation to angina.
Pregnancy and the skeletal complications of sickle cell disease
Authors: Akinla Oladele
Published: December 2008

An account is given of three patients with the skeletal complications of sickle cell disease in association with pregnancy. Avascular necrosis of bone and acute osteomyelitis are the usual forms of these complications.

The associated high perinatal mortality is probably due to the constant hypoxia to which the foetus is exposed during both pregnancy and labour.
Minimal dose of a stimulus for maximal pepsin secretion
Authors: Desai H G , Zaveri M P , Antia F P
Published: December 2008

Dose-response curves were obtained with subcutaneous histamine acid phosphate (HAP) in twenty-two subjects, intravenous HAP in fifteen subjects, subcutaneous pentagastrin in fourteen subjects and intravenous pentagastrin in twelve subjects in order to determine the minimal doses of these stimuli for maximal pepsin secretion.

The minimal doses for maximal pepsin secretion were 2·8 mg HAP on SHT, 1·2 mg/hr HAP on IHT, 300 μg pentagastrin on SPT and 100 μg/hr pentagastrin on IPT.
Hepatic manifestations during amoebic dysentery
Authors: Ramachandran S , Rajapakse C N A , de Saram R , Sivalingam S
Published: December 2008

A variety of hepatic manifestations may occur during attacks of acute amoebic dysentery, conforming to clearly defined clinical groups.

The incidence of definite hepatic involvement presenting as cases of hepatic amoebiasis with or without demonstrable pus or with tender hepatomegaly was 57·5%.

While it is possible that the cases presenting with hepatic manifestations without demonstrable pus are due to small deep-seated abscesses, the non-specific nature of the histological lesions observed in the study and the inability to demonstrate the presence of amoebae in the lesions support the contention that these hepatic manifestations may represent a non-specific reaction in the liver to amoebic ulceration of the colon.

Chest radiology may be helpful in confirming the clinical evidence of hepatic involvement but the leucocyte count, ESR, and the serum enzymes are of limited value in indicating both its presence and type.

Patients manifesting hepatic involvement during attacks of amoebic dysentery should be adequately treated with tissue amoebicidals. This therapeutic approach would be useful in reducing the incidence of hepatic amoebiasis.
Changes in glucose tolerance, insulin, serum lipids and lipoproteins in patients with renal failure on intermittent haemodialysis
Authors: Arora K K , Trafford J A P , Atkinson M K , Sheldon J , Nunn R
Published: December 2008

Fasting serum lipids and lipoprotein patterns, glucose tolerance and serum insulin response to glucose were investigated in eight patients with renal failure on intermittent haemodialysis and five normal controls. The mean 0·5, 1 and 2 hr blood glucose values were significantly higher in patients compared with controls but there was no significant difference between patients and controls in respect of fasting serum insulin levels or the insulin response to glucose. Six of the eight patients showed hypertriglyceridaemia (hyperprebetalipoproteinaemia).
Plasma lipids, blood coagulation and fibrinolysis in peripheral arterial disease
Authors: Newall R G , Bliss B P , Kirk C J C
Published: December 2008

In a study relating platelet stickiness, plasma fibrinogen and fibrinolysis to fasting plasma lipids in patients with atherosclerosis of the lower limbs, a significant correlation has been observed between platelet stickiness and plasma phospholipid levels. The possible mechanisms are discussed. No other correlation is observed. Fasting levels of plasma fibrinogen were raised, while levels of plasminogen, and the degree of platelet stickiness in many cases were normal.
Epidemiological features of subarachnoid and cerebral haemorrhages
Authors: Talbot S
Published: December 2008

A study of coroner's necropsy statistics showed that subarachnoid and cerebral haemorrhage were important causes of sudden death in the community. There were more sudden deaths due to cerebral haemorrhage in women than in men but this was due to the increasing frequency of this condition with age and the sexes were equally affected if standardized mortality rates were calculated. Comparison with a study of hospital necropsy statistics showed that the latter was a selected group, elderly patients (predominantly women) being found less frequently. Deaths due to subarachnoid haemorrhage occurred as commonly in men as in women, but were rare over the age of 60 years. This fact probably accounted for the similar epidemiology of these fatal cases in the hospital and the community.

There was no significant seasonal variation in the death rate due to either cerebral or subarachnoid haemorrhage if surgically treated cases were excluded.

The mortality of both these conditions was highest at the onset and rapidly decreased. A secondary rise in mortality due to subarachnoid haemorrhage occurred between the sixth and eighth days after the onset in the hospital group. The length of survival before treatment is an important prognostic factor and must be known before the effect of treatment can be assessed.
Aetiology of postmenopausal bleeding
Authors: Keirse M J N C
Published: December 2008

A retrospective analysis has been made of 160 cases of postmenopausal bleeding. The women were at least 45 years old and the time lapse from the last menstruation was at least 2 years.

The cause was a malignant neoplasm in 23·75%. The incidence of malignancy showed a definite rise with advancing age and with increasing duration of bleeding. It was nearly twice as high in women who stopped menstruation after the age of 55 years. Malignancy also seemed to be more frequent in patients with profuse bleeding and in those who had amenorrhoea lasting for 20 years or more.

The most usual malignant lesions were endometrial and cervical carcinoma, the ratio of these two conditions being 1·6: 1. Oestrogen administration was the most common cause in the non-malignant group: 12·5%. No cause for bleeding could be demonstrated in 8·8%.

The aetiology of postmenopausal bleeding is discussed.
I-cell disease—mucolipidosis II
Authors: Gordon Neil
Published: December 2008

I-cell disease is an example of the mucolipidoses, a group of diseases which show features of both the mucopolysaccharidoses and the sphingolipidoses. A clinical description is given of a child suffering from this condition. The diagnostic criteria are discussed, as well as some of the necropsy findings.
The use of intra-arterial Urokinase in a case of recurrent arterial occlusion
Authors: Boucher B J , Connolly E M , Farrow S C
Published: December 2008

The present case report describes the use of intraarterial Urokinase in an occlusive episode involving the right radial and ulnar arteries. Details of the case history are given and the choice of thrombolytic therapy, plus its route of administration are discussed.
Radioisotope scanning of brain, liver, lung and bone with a note on tumour localizing agents
Authors: Lavender J P
Published: December 2008

Radioisotopic scanning of brain, liver, lungs and the skeleton is briefly reviewed with a survey of recent developments of clinical significance. In brain scanning neoplasm detection rates of greater than 90% are claimed. The true figure is probably 70–80%. Autopsy data shows a number of false negatives, particularly with vascular lesions. Attempts to make scanning more specific in differentiating neoplasm from vascular lesions by rapid sequence blood flow studies are reviewed.

In liver scanning by means of colloids again high success rate is claimed but small metastases are frequently missed and the false negative scan rate is probably quite high.

Lung scanning still has its main place in investigating pulmonary embolic disease. Ventilation studies using Xenon 133 are useful, particularly combined with perfusion studies.

The various radiopharmaceuticals for use in bone scanning are reviewed. The appearance of technetium labelled phosphate compounds will probably allow much wider use of total skeletal scanning.

Research into tumour localizing agents continues, the most recent and interesting being Gallium citrate and labelled bleomycin. Neither agent is predictable however although Gallium may have a place in Hodgkins disease and bronchogenic neoplasm and both may have a place in the detection of cerebral tumours.
The diagnosis of thyrotoxicosis
Authors: Greig William R , McDougall Iain R , Gray Henry W
Published: December 2008

Thyrotoxicosis is a clinical syndrome due to excessive amounts of thyroid hormone in the circulation and tissues. Graves' disease, goitre and exophthalmos, is the commonest variety, but in some parts of the world thyrotoxicosis supervenes on the background of a long standing nodular goitre. Other varieties such as ectopic TSH syndromes are very rare.

The diagnostic sequence in practice starts with clinical suspicion and a decision can often be made on the symptoms and signs alone. It is, however, always advisable to confirm the presence or absence of thyrotoxicosis. There has been re-orientation in the simple test procedure used in this respect. Measurements such as serum TSH and serum TSH response to TRH and measurements of serum LATS levels are available only in a few centres and are not discussed in detail.

Tests based on the carriage of thyroid hormones in the blood are preferable to in vivo radionuclide studies, particularly when the patient is thought to be euthyroid. We advise a serum PB127I and serum total thyroxine estimation in all patients. If the data are abnormal we add a serum T3 resin estimation to check whether the values are due, for example, to iodine contamination or altered binding.

We advise radionuclide studies in all doubtful cases and measurements such as the 4 hr or 24 hr 131I uptake and the 48 hr serum PB131I are very helpful. A thyroid uptake suppression test may be required if there is still doubt. In general those patients going for thyroidectomy or 131I therapy should have a scan performed. With improved technology much safer radionuclides, such as 123I or 99mTc, may be usable when thyrotoxicosis is suspected in children or during pregnancy.
The use of total-body counters for the study of iron metabolism and iron loss
Authors: Warner G T
Published: December 2008

Total-body counters designed for clinical use have considerable advantage and application over other methods for the measurement of iron metabolism. An investigation may be performed on an out-patient basis and the need for faecal collections avoided.

Although the initial cost of their installation is high, this can be off-set by the saving of in-patient costs in 2 or 3 years of operation.
The investigation of renal disease using radionuclides
Authors: Atkins Harold L , Freeman Leonard M
Published: December 2008

The use of radioactive labels for tracers is an important part of the investigation of renal disease. These techniques seldom replace, but often complement radiographic techniques. Generally, the radionuclide methods provide functional and dynamic information in a non-invasive, non-traumatic type of examination. The examinations usually are relatively simple to perform and carry a very low risk of untoward reaction.

The past decade has seen significant advances in radiopharmaceutical design and instrumentation. It is expected that the next decade will produce an even greater advance in this field.
The renal excretion of nutrients in pregnancy
Authors: Hytten F E
Published: December 2008

A feature of normal pregnancy is a huge increase in the excretion of nutrients in urine. Glycosuria is commonplace, and about half of all healthy pregnant women excrete more than when not pregnant. Amounts in excess of 1 g/24 hr are common, and excretion is characteristically intermittent with little apparent relation to plasma levels. Amino acid excretion is also raised four or five times by late pregnancy, with a characteristic pattern for different amino acids, and folate and other water soluble vitamins are similarly squandered. The mechanisms are not understood.
Villous adenoma in a blind duodenal loop
Authors: Jones P E , Clegg J F
Published: December 2008

A case of a villous adenoma in a blind duodenal loop is described. The difficulties in diagnosis are illustrated and the literature on duodenal villous tumours is reviewed.
Ankylosing spondylitis and auto-immunity
Authors: Cowan G O
Published: December 2008

A case of ankylosing spondylitis is described in which a relationship with gastric and endocrine autoimmunity could be demonstrated.
Agranulocytosis associated with sulphasalazine therapy
Authors: Cochrane P , Atkins P , Ehsanullah S
Published: December 2008

A case report of a patient with agranulocytosis associated with sulphasalazine therapy is described. Recovery followed supportive therapy and withdrawal of the drug. Investigations including tests for leucocyte antibodies, the presence of which might have suggested an immunological cause for the drug reaction, were negative; an acetylation study, however, characterized the patient as a ‘slow’ acetylator phenotype, suggesting that the drug reaction was more likely to have been toxic in nature. It is suggested that acetylation studies be performed in patients who have previously shown serious side effects to sulphasalazine to assess the incidence of ‘slow’ acetylators.
Passive smoking: Absorption by non-smokers of carbon monoxide from room-air polluted by tobacco smokeThis article is reproduced from the Lancet (1973) i, 576, by kind permission of the Editor.
Authors: Russell M A H , Cole P V , Brown E
Published: December 2008

Twenty subjects spent a mean of 78 min seated in an unventilated smoke-filled room of approximately 43 m3 (15 × 12 × 8 ft). The smoke was produced by burning and smoking eighty cigarettes and two cigars. The average ambient carbon monoxide (CO) concentration was 38 ppm. Blood samples taken before and after the exposure showed an increase in carboxyhaemoglobin (COHb) in all subjects without exception (P < 0·001). The COHb of the twelve non-smokers increased from a mean of 1·6% to 2·6% (P < 0·001), while the six cigarette smokers, all inhalers, besides having significantly higher initial levels (P < 0·001) also showed a greater increase from a mean of 5·9% to 9·6% (P < 0·001). The two cigar smokers, one an inhaler, the other a non-inhaler, showed respective COHb changes similar to the cigarette smokers and non-smokers. The mean increase of 1% COHb among the non-smokers was similar to the mean increase for the smokers of 0·7% for each cigarette smoked, suggesting that the amount of CO which the non-smokers absorbed by passive smoking was about the same as would be expected if they had actively smoked and inhaled one cigarette.
Turner's syndrome with coeliac disease, thin bones and abnormal liver function tests
Authors: Thatcher N , Stephens A D , Besser G M
Published: December 2008

A patient is described with 45 XO Turner's syndrome and thin bones. It transpired that the patient had osteomalacia due to gluten sensitive enteropathy rather than the osteroporosis usually expected with Turner's syndrome. In addition, she had unexplained liver dysfunction. Causes for thin bones other than the osteoporosis associated with ovarian agenesis should be considered in patients with Turner's syndrome.
The work of a psychosurgical unit
Authors: Bridges P K , Bartlett J R
Published: December 2008

The widespread use of standard leucotomy terminated in the early 1950's with the advent of the phenothiazine group of drugs. But since then, psychosurgical techniques have been considerably refined and the indications for the newer operations are becoming increasingly precise. Knight's (1969) stereotactic tractotomy is probably the most frequently performed contemporary operation for the relief of some psychiatric illnesses, and the number of patients now referred for this treatment have justified the organization of a specific unit for the purpose.

The value of such a special unit, involving close co-operation between neurosurgeon and psychiatrist is emphasized. It provides a supportive environment for patients who are sharing a highly specialized treatment, and offers opportunities for studying outcome after operation with resulting improvement in selection. It also facilitates research possibilities in general. The clinical work of the Geoffrey Knight Psychosurgical Unit, probably in its way unique, is described and questions often encountered from doctors and from patients are considered. The importance of rehabilitation after operation is stressed and some aspects of the longer term post-operative psychiatric care involved are dealt with.
Acute renal failure complicating McArdle's syndrome
Authors: Ford P M , Weir W R C , Manugian A A H
Published: December 2008

A case of McArdle's syndrome is described in which an epileptiform seizure was followed by acute reversible renal failure with hypercalcaemia in the diuretic phase.
Chronic liver disease associated with childhood ulcerative colitis
Authors: Toghill P J , Benton K P E , Smith P G
Published: December 2008

In a series of 301 patients with ulcerative colitis forty-eight developed the disease before the age of 20. In this group of forty-eight patients there were four cases of serious chronic liver disease as compared with a total of seven cases of chronic liver disease in the whole series. The hepatic lesions in the patients developing colitis in childhood were unrelated to the extent, duration or severity of the colitis but colitis in very early life appeared to predispose to liver disease subsequently.
Drugs for rare diseases
Authors: Lyle W H
Published: December 2008

Pharmaceutical houses alone are equipped to market new medicines. The cost is very high, much of this arising from the preliminary toxicological and pharmacological work which is required in order to satisfy licensing authorities.

The introduction of a drug, even for a rare and lethal disease without such data, even if permitted by the authorities, would leave its manufacturer exposed to adverse publicity and litigation in the event of a mishap.

These considerations have had the effect of stifling original work in the drug treatment of rare diseases, the position having worsened in recent years.

This trend is illustrated by the history of the introductions of penicillamine and triethylene tetramine for Wilson’s disease.
How should we prescribe?
Authors: Vere D W
Published: December 2008

Approved names, though often bulky, are preferable on balance to brand names because they identify drugs precisely by compound, often revealing derivation and class of action as well. Brand names at present have the advantage of identifying a preparation. This affirms bio-availability, if that is known, and safeguards the consumer’s legal position. But both advantages are against drug defects. It should therefore be hoped that they will become obsolete through pharmaceutical progress, and so do not constitute a lasting reason to confound prescribing accuracy with financial expediency.
Prescribing and the regulation of formulation
Authors: Beckett A H
Published: December 2008

Unless the equivalence of different products has been established, the prescriber must define the product he requires by using the trade name. Present pharmacopoeial standards based on in vitro methods are inadequate to predict equivalence in man. There are many ways in which differences in formulation may influence absorption of drugs, and only comparable absorption profiles can be taken as evidence of equivalence.
Is this a world-wide problem?
Authors: Stevens C C B
Published: December 2008

Substitution is a worldwide problem arising from professional pride and status and pressure of economics. Substitution, legal or otherwise, is encouraged by governments, international agencies, professional and quasi-official bodies.

Some faults lie in industry and the developing use of marks but generally it is economic pressures at a time of restricted resources and increasing demand that make for economy in all sections. It is thought that the use of generic names aids economy and that is why restrictions are placed on marks in all parts of the world.
The department of health
Authors: Cornah G
Published: December 2008

Brand name prescribing accounts for most of the cost of drugs to the National Health Service. Substantial savings would result from generic prescribing of certain commonly used drugs including phenylbutazone, imipramine, tetracycline and paracetamol.
The nurse
Authors: Stevenson J
Published: December 2008

Nurses are usually taught approved names for drugs, but this leads to confusion with combination products. Problems in drug administration arise when one name is marked on the bottle of tablets and the other name on the prescription sheet. From the nurses’ point of view, standardization is essential.
The clinical pharmacologist
Authors: Turner P
Published: December 2008

Differences in formulation are of greater clinical importance in the case of sparingly soluble drugs, those with small therapeutic doses, in replacement therapy and in the control of serious clinical conditions with compounds having a low therapeutic index: this subject should receive specific attention in medical teaching and in clinical trials.
Road traffic accident fatalities (review of 142 post mortem reports)
Authors: Kamdar B A , Arden G P
Published: December 2008

One hundred and forty-two post mortem reports of road accident deaths in the Windsor accident area have been reviewed. Although head and chest injuries accounted for the deaths of most of these victims, twelve died of inhalation asphyxia and another eighteen died of hypovolaemia due to haemorrhage from otherwise minor injuries. Some of these cases would perhaps have survived if they had received skilled medical attention at the most critical time.