bluuebunny/crossref_metadata_2025 huggingface dataset:
Idiopathic retroperitoneal fibrosis--is serum alkaline phosphatase a marker of disease activity?
Authors: Barrison I G , Walker J G , Jones C , Snell M E
Published: December 2008

Two patients are presented in whom extensive investigations were carried out to determine the cause of a raised serum alkaline phosphatase. Idiopathic retroperitoneal fibrosis was diagnosed in both cases and the serum alkaline phosphatase returned to normal following treatment with corticosteroids and coincident with resolution of the patients’ symptoms.
Neuropsychiatric symptoms following bismuth intoxication
Authors: Weller M P I
Published: December 2008

A number of seemingly neurotic symptoms, similar to those reported in bismuth intoxication, occurred in a patient taking a proprietary dyspeptic preparation, tri-potassium dicitrate bismuthate (De-Nol), over 2 years. The symptoms remitted over 10-12 months after stopping the drug - a similar period to that described in bismuth intoxication and the patient has remained symptom-free for 7 years. Possible mechanisms are discussed.
Spontaneous duodenocutaneous fistula: a rare complication of duodenal ulcer
Authors: Reddy A N
Published: December 2008

Fistula formation between the duodenum and the skin of the anterior abdominal wall is a rare complication of duodenal ulcer disease, most often felt to occur following ulcer surgery. The development of a spontaneous duodenocutaneous fistula in association with duodenal ulcer has not been hitherto reported. A middle aged man with a history of peptic ulcer for more than 10 years, and a vagotomy and pyloroplasty 15 months earlier, presented with an asymptomatic duodenocutaneous fistula, presumably secondary to a perforated duodenal bulb ulcer. Successful healing of the fistula was accomplished by non-surgical therapy consisting of nasogastric suction, intravenous alimentation and parenteral cimetidine over a 4-week period.
Pyogenic liver abscess with two normal ultrasound scans
Authors: Bunney R G
Published: December 2008

I report a case of a large liver abscess causing a severe debilitating condition in which the diagnosis was delayed by several weeks following two normal ultrasound scans at days 5 and 19 of the illness.

Up to one in four cases of liver abscess can be missed on ultrasound. A high degree of clinical suspicion must be maintained and repeated or alternative imaging methods used if the diagnosis of this rare, curable but often fatal condition is not to be missed.
Bilateral inguinal hernias: simultaneous or sequential repair?
Authors: Stott M A , Sutton R , Royle G T
Published: December 2008

Two hundred and forty four patients underwent either simultaneous bilateral inguinal hernia repair (n = 122) or unilateral inguinal hernia (n = 122) repair at a general hospital between January 1971 and December 1981. The two groups of patients were matched for age and sex. Both groups had a similar overall incidence of post-operative complications and in both groups the duration of post-operative stay and duration of operating time were similar. Chest infections developed in 12 patients after bilateral repair and in 3 patients after unilateral repair (P less than 0.02). All patients were assessed prospectively from 4 to 15 years after operation, when no significant difference in the number of recurrent hernias was found. Our results suggest that simultaneous bilateral inguinal herniorrhaphy is economical in terms of both operating time and duration of hospital stay, and that this economy is not bought at a cost of increased short term morbidity or long-term recurrence rate.
Rapid recovery of acute transverse myelitis treated with steroids
Authors: Kennedy P G E , Weir A I
Published: December 2008

A case of acute transverse myelitis is described in which steroid therapy was followed by a remarkably rapid clinical and electrophysiological recovery. A possible explanation is proposed.
Alveolar soft-part sarcoma: a hormone-sensitive tumour?
Authors: Pang J A , Yeung T F , Cockram C S
Published: December 2008

Alveolar soft-part sarcoma is a rare, slow-growing, malignant tumour which metastasizes frequently to the lungs. Treatment with radiotherapy or chemotherapy is largely ineffective, and most patients die within 4 years of developing metastases. We report an unusual patient who survived 9 years after detection of pulmonary metastases. Initial treatment with cytotoxic chemotherapy was ineffective. However, during subsequent treatment with Chinese herbs when she developed galactorrhoea and amenorrhoea (probably due to drug-induced hyperprolactinaemia), her lung metastases regressed, and it is likely that this contributed to her prolonged survival. We hypothesize that alveolar soft-part sarcoma may be a hormone-sensitive tumour, and hormonal manipulation may be an alternative form of treatment which is worth considering.
Foscarnet as treatment for cytomegalovirus retinitis following bone marrow transplantation
Authors: Ganly P S , Arthur C , Goldman J M , Schulenburg W E
Published: December 2008

This report describes a patient with chronic granulocytic leukaemia who developed cataracts on busulphan treatment. Following allogeneic bone marrow transplantation, he developed cytomegalovirus retinitis, which was treated successfully with trisodium phosphonoformate (foscarnet). Cytomegalovirus retinitis and its therapy, and busulphan-induced cataract are discussed.
Serious complications following treatment of chronic idiopathic thrombocytopenic purpura
Authors: Wanachiwanawin W , Visudhiphan S , Piankijagum A , Vatanavicharn S
Published: December 2008

Six patients had serious complications as consequences of treatment of idiopathic thrombocytopenic purpura. Five had splenectomy-related complications, one of them developed fatal intra-abdominal bleeding. Three patients acquired operation-related serious infection, two of them died. Serious neutropenia after vinblastine-loaded platelets occurred in one patient leading to pseudomonas septicaemia and panophthalmitis with permanent vision loss of left eye. Recurrence thrombocytopenia occurred in every case during serious complications. Early detection by awareness of the possibility of serious complications can reduce morbidity and mortality occurring after therapy of idiopathic thrombocytopenic purpura.
Haemolytic anaemia associated with ingestion of naphthalene-containing anointing oil
Authors: Ostlere L , Amos R , Wass J A H
Published: December 2008

We present a patient who developed a severe haemolytic anaemia as a result of ingestion of a naphthalene-containing anointing oil. Previous reports of naphthalene-induced haemolytic anaemia are reviewed. Predisposing factors to haemolysis are outlined and the variability in the haematological response to naphthalene is discussed. It is clear that ingestion of anointing oil is dangerous; even topically, significant absorption of naphthalene may occur especially in infants, as it is oil-based. Because of these dangers, the use of naphthalene-containing anointing oils should be strongly condemned.
Bilateral dislocation of the shoulders due to nocturnal hypoglycaemia
Authors: Litchfield J C , Subhedar V Y , Beevers D G , Patel H T
Published: December 2008

A young insulin-dependent diabetic awoke with apparently spontaneous bilateral anterior dislocation of his shoulders. The most likely explanation was nocturnal hypoglycaemia. Similar case reports describing this complication have not been discovered.
Pericardial involvement in familial Mediterranean fever
Authors: Erol C , Sonel A , Candan İ , Ömürlü K , Ȧkyol T
Published: December 2008

Two patients with familial Mediterranean fever showed the classic features of pericardial involvement and one of them (Case 2) had pericardial effusion detected by echocardiography.

These and previously published cases show that familial Mediterranean fever should be considered as a cause of pericarditis and/or pericardial effusion.
Pancreatic pleural effusion associated with oncocytic carcinoma of the pancreas
Authors: England D W , Kurrein F , Jones E L , Windsor C W O
Published: December 2008

A pancreatic pleural effusion is an uncommon presenting feature of pancreatic malignancy. A case is described where such an effusion was associated with an oncocytic carcinoma of the pancreas, a tumour which itself has been reported on only one previous occasion.
Widespread cutaneous vasculitis associated with diltiazem
Authors: Sheehan-Dare R A , Goodfield M J D
Published: December 2008

Two cases of widespread cutaneous vasculitis are described in association with diltiazem, a recently introduced calcium antagonist. In both cases, spontaneous resolution occurred over several weeks following withdrawal of the drug.
Premises for immune interventional therapy in rheumatoid arthritis
Authors: Mackay I R , Rowley M J
Published: December 2008

Consideration of rheumatoid arthritis (RA) as an autoimmune disease includes initiating event(s), genetic predisposition, immune regulatory derangements, and effector cycles of articular damage. The initiating event is still unknown. Collagen type 2 has good claims as a rheumatogenic autoantigen which perpetuates disease. The association of HLA DR4 with rheumatoid arthritis is in part explainable by the affinity of binding of the rheumatogenic antigen to a hypervariable portion of MHC Class II molecules with selective presentation of this complex to T cell receptors. Immune regulatory derangements include lymphokine-induced aberrant expression of MHC Class II molecules on synovial tissues, the presence of a ‘resistant’ subset of B cells (CD5 + ve), failure of anti-idiotypic control of autoantibodies (not well established as yet in rheumatoid arthritis), and defective immune suppression, revealed by low counts in synovial fluids of a suppressor-inducer subset of CD4 + ve T cells. The many possibilities for therapeutic immune intervention would include polyclonal or monoclonal antibody to block (a) receptors for antigen on B or T lymphocytes (but this would require knowledge of the rheumatoid arthritis-inducing antigen), (b) the CD4 complex on helper T lymphocytes, (c) MHC Class II (Ia) molecules, for which there are excellent prototypes in experimental immunopathology, or (d) lymphokines or their receptors. Induction of suppression by ‘tolerogenic vaccines’ is experimentally validated, but only for diseases for which an autoantigen can be identified.
Immune aspects of sarcoidosis
Authors: Poulter L W
Published: December 2008

Although the initiating factor(s) is unknown, it is now accepted that pulmonary sarcoidosis develops as a result of an over-stimulated local cellular immune response. Starting as a lymphocytic alveolitis, there is a progression to granuloma formation within the interstitium as stimulated T lymphocytes release mediators capable of attracting and activating monocytes to differentiate into macrophages and epithelioid cells. We are also aware that macrophage-like cells must act as antigen presenters to initiate T cell stimulation within the immune response. To date, interest in the alveolar macrophages of patients with sarcoidosis has focused more on their passive role as responders of the soluble T cell products released as the disease progresses. This paper explores the active role of mononuclear non-lymphoid cells as inducers of immune responses, by taking advantage of monoclonal antibodies capable of discriminating between phenotypically distinct subsets of macrophages. Recent results are presented that suggest a central role for these cells in controlling the course of this disease, focusing specifically on the mechanisms underlying the failure in some patients to resolve the interstitial inflammation and subsequently progressing to fibrosis. A new hypothesis proposes that aberrations in the functional capacity of macrophages may prohibit the emergence of a granuloma-resolving mechanism in some sarcoid patients.
Post-infectious disease syndrome
Authors: Bannister B A
Published: December 2008

Many post-infectious syndromes have been recognized in the last 50 years, some following viral infections and others closely related to bacterial disease. The occurrence of prolonged fatigue following an apparent viral illness of varying severity is also well documented. The lack of a recognizable precipitating cause and the tendency for epidemic fatigue to occur among hospital staff led many to believe that the illness may be psychogenic in origin. However, there is serological evidence that some cases may follow enterovirus infections or occasionally delayed convalescence from infectious mononucleosis.

Much interesting work is currently in progress relating fatigue to persisting immunological abnormalities, and the development of molecular immunology makes this a most exciting field of research.

This paper reviews the evidence for and against a definitive post-viral fatigue syndrome and examines the results of research carried out in the last 50 years.
Augmentation and reduction mammaplasty: demographic and obstetric differences in women attending a National Health Service clinic
Authors: Birtchnell S , Lacey J H
Published: December 2008

Women presenting for breast augmentation and breast reduction to a National Health Service plastic surgery/psychiatry liaison clinic appear to differ beyond the anatomical. Those requesting breast reduction tend to be younger, unmarried and not to have been pregnant and may be uncomfortable with adult sexuality. Those requesting breast augmentation are presenting for surgery in their mid-thirties although many have always had small breasts. This is at a time of fading attractiveness, marital difficulties and a sense of failure as a woman. We report a strikingly poor obstetric history in this group.
Mycotic aneurysm of the popliteal artery following right hemicolectomy
Authors: Narula A , Lake S P , Baker A R , Greenwood R K
Published: December 2008

A case of mycotic aneurysm of the popliteal artery, following right hemicolectomy for carcinoma, is described. This was treated by ligation and excision without bypass grafting. The clinical features are discussed and the literature reviewed.
Further evidence for the effect of passive smoking on neonates
Authors: Campbell M J , Lewry J , Wailoo M
Published: December 2008

From 518 couples with a 1 month old baby, information was obtained on the couple’s smoking habit, social class, age of mother, parity, alcohol consumption during pregnancy and respiratory symptoms of the baby. Allowing for these factors, a multivariate analysis revealed that, even allowing for mother’s smoking habit, babies whose father smoked were lighter at birth by an average of 113 g (95% CI 8-216 g) and this effect was unchanged at 1 month (112 g, 95% CI 0-224 g). Babies whose mothers smoked were twice as likely to have a cough (Relative Risk = 2.0, 95% CI 1.05-3.68), than those whose mothers did not, but we failed to find a significant association with the father’s smoking habit.
The efficiency and effectiveness of geriatric day hospitals
Authors: Zeeli D , Isaacs B
Published: December 2008

One hundred patients who were referred consecutively to two geriatric day hospitals were followed for 3 months, to determine the efficiency and effectiveness of day hospital management. Transport was highly efficient; only one in every 40 attendances failed because of transport. Selection of patients may have been less efficient, in that only half completed planned treatment. In most cases this was because of progression of the illness. Time at the day hospital was on the whole efficiently used, in that three-quarters of the time was devoted to programmed activities. The effectiveness of the day hospital was limited. In only about one-third of referred patients were the objectives set by the doctor attained. Likewise only one-third of patients felt that they had improved, and one-third of carers experienced relief of strain.
The haematology of hyperthyroidism: abnormalities of erythrocytes, leucocytes, thrombocytes and haemostasis
Authors: Ford H C , Carter J M
Published: December 2008

The abnormalities of erythrocytes, leucocytes, thrombocytes and coagulation that have been reported, particularly in more recent years, to be associated with hyperthyroidism are surveyed. Several areas are highlighted where further investigations could lead to clinically useful insights, improved information about the haematological processes involved or to a better understanding of thyroid hormone action.
Management of acute liver failure
Authors: Williams R
Published: December 2008

The principles of management for acute liver failure are: 1. Accurate diagnosis of the type--fulminant, late onset, acute on chronic--and establishment of likely aetiology. 2. Early detection and treatment of complications, particularly metabolic acidosis (early), renal failure, cerebral oedema and infections (late). 3. Optimization of conditions for regeneration by maintenance of normal metabolic milieu (? removal of toxins). 4. Early consideration of an orthotopic liver transplant for poor prognosis group.
Delayed tension pneumothorax complicating staphylococcal pneumonia
Authors: Yates S P , Morcos S K
Published: December 2008

A case is described in which a tension pneumothorax complicated staphylococcal pneumonia 11 months after its onset. The delayed and subacute/chronic nature of the tension pneumothorax is unusual. The case also highlights the difficult differential diagnosis between subpleural lung cysts and encysted pneumothorax.
Infectious mononucleosis: a cause of bilateral hilar lymphadenopathy
Authors: Friedland J S , Santis G , Smith M J
Published: December 2008

We present a case of bilateral hilar lymphadenopathy which illustrates that infection by the Epstein-Barr virus should always be considered in the differential diagnosis of this condition.
Gastric adenocarcinoma associated with adenomyoma of the stomach
Authors: Chapple C R , Muller S , Newman J
Published: December 2008

We report a case of gastric adenomyoma contiguous with adenocarcinoma of the stomach. Although a similar association is well recognized in the duodenum, we believe this to be the first documented case in the stomach. We review the literature on adenomyomata and discuss the implications of this finding. It would appear that glandular and cystic intramural lesions of the stomach are a heterogeneous group, and while there is a well established association between gastric carcinoma and gastritis cystica profunda, the same does not apply to gastric adenomyoma.
Lipohypertrophy and lipoatrophy complicating treatment with highly purified bovine and porcine insulins
Authors: McNally P G , Jowett N I , Kurinczuk J J , Peck R W , Hearnshaw J R
Published: December 2008

Lipoatrophy and lipohypertrophy were the most frequently reported local complications of conventional insulin therapy. Early reports following the introduction of highly purified insulins suggested a reduction in the frequency of lipohypertrophy and lipoatrophy. Since highly purified insulins have been in common usage for 10 years, the present frequency of these complications was assessed in a study of 281 insulin treated diabetics. Lipohypertrophy was recorded in 76 (27.1%) patients including 3 with associated lipoatrophy. Lipoatrophy was found in 7 (2.5%) cases (3 porcine and 4 bovine insulin treated), 4 of which had only ever used highly purified insulins. Despite the introduction of highly purified insulins, lipohypertrophy and lipoatrophy remain prevalent in insulin treated patients. This common complication may be limited by routinely inspecting injection sites.
Rapid urease test provides specific identification of Campylobacter pylori in antral mucosal biopsies
Authors: Szeto M L , Pounder R E , Hamilton-Dutoit S J , Dhillon A P
Published: December 2008

In a prospective study, three antral biopsies were taken from 175 dyspeptic patients during routine endoscopy. One biopsy was inserted immediately into a gel-containing well of a CLOtest slide and two biopsies were sent to histopathology. Using the CLOtest, 84 of the 175 samples (48%) detected urease activity in the gastric biopsy, suggesting infection with Campylobacter pylori. Histopathological examination by two independent observers reported that 93 (52%) of the biopsies contained Campylobacter-like organisms. The CLOtest was found to have a specificity of 1.0 and sensitivity of 0.91, providing a rapid identification of most patients harbouring the organism in their gastric mucus.
Porphyria cutanea tarda in association with the human immunodeficiency virus infection
Authors: Ong E L C , Ellis M E , McDowell D , Gebril M , Weinkove C , Ead R
Published: December 2008

A 42 year old heterosexual male with symptomatic human immunodeficiency virus infection presented with a 2-week history of tense blistering skin lesions following azidothymidine therapy. Urinary porphyrin excretion confirmed the diagnosis of porphyria cutanea tarda. The blisters resolved following the withdrawal of the drug but recurred when rechallenged. Three other cases of porphyria cutanea tarda, not associated with azidothymidine, who subsequently developed acquired immunodeficiency syndrome have recently been described. If azidothymidine is not the precipitating agent, it is possible that human immunodeficiency virus itself can impair porphyrin metabolism, leading to the clinical and biochemical features of porphyria cutanea tarda.
How do we know who has had deep vein thrombosis?
Authors: Sandler D A , Mitchell J R A
Published: December 2008

An attempt was made to identify all patients diagnosed as having deep vein thrombosis (DVT) in a large teaching hospital during one year. A review of the radiology records showed that 124 (81%) of the 154 venograms performed were for suspected DVT, and that the diagnosis was confirmed in 57 (46%). During the same period, the Hospital Activity Analysis (HAA) records revealed 174 episodes classified as ‘phlebitis or thrombophlebitis’ in 162 patients. Only 37 of these episodes (21%) had been confirmed by X-ray venography and at least 29 patients were incorrectly classified by HAA. ‘Medical’ patients accounted for 54% of the episodes of DVT, yet in only 25% of these was the diagnosis confirmed by venography, while ‘surgical’ DVTs were less frequent but were more often confirmed by venography.
The black thyroid: an unusual finding during neck exploration
Authors: Noble J G , Christmas T J , Chapple C , Katz D , Milroy E J G
Published: December 2008

Black thyroid discolouration has been reported in post-mortem examinations on patients who have previously taken minocycline. The discovery of this phenomenon during neck exploration and a review of the possible mechanism of black thyroid discolouration are discussed in this paper.
Transvenous pacemaker electrodes placed unintentionally in the left ventricle: three cases
Authors: Winner S J , Boon N A
Published: December 2008

Three patients are described in whom pacemaker electrodes were unintentionally placed within the left ventricle, followed by considerable delay before the error was recognized. In two cases temporary pacemaker wires were inserted into the subclavian artery and passed along a retrograde course. One patient required urgent surgery for acute arterial obstruction on removal of the wire. In the third case, a permanent wire was inserted correctly into a vein but traversed the atrial septum, probably via a patent foramen ovale, to enter the left ventricle. Twelve lead electrocardiograms in all three patients showed paced complexes with right bundle branch block configuration. This appearance should raise suspicion that the pacemaker electrode might be in the left ventricle, in which case its position should be defined by chest radiographs (including a lateral view) and echocardiography.
Anticardiolipin antibody levels in diabetic subjects with and without coronary artery disease
Authors: Hendra T J , Baguley E , Harris E N , Khamashta M H , Trembath R C , Hughes G R V , Yudkin J S
Published: December 2008

Moderate (greater than 20 units) and high (greater than 80 units) IgG anticardiolipin antibody (aCL) titres are strongly predictive for recurrent thrombosis and early myocardial infarction in non-diabetic subjects. We have tested the hypothesis that the excess risk of myocardial infarction in diabetic subjects relates to the presence of aCL by measuring the frequency and titre of aCL in two groups of diabetic subjects and in 2500 healthy controls. One non-diabetic subject (0.04%) had low (5-20 units) IgG aCL titres. Seven out of 126 diabetics without cardiovascular disease (5.6%) and 9 out of 79 diabetics who were either myocardial infarction survivors or who had angiographically-proven coronary artery disease (11.4%) had low aCL titres (P less than 0.01 for comparison of either diabetic group with controls, and P less than 0.1 for comparison between diabetic groups). One subject in each diabetic group, but no non-diabetics, had moderate IgM aCL titres. No subjects had high aCL titres. Diabetics have an increased frequency of low aCL titres which may relate to macrovascular disease. Macrovascular disease in diabetics is not associated with moderate or high aCL titres.
False aneurysm formation after Salmonella virchow infection of a pre-existent ventricular aneurysm--survival after surgical resection
Authors: Echevarria S , Arjona R , Alonso J , Riancho J A , Revuelta J M , Macias J G
Published: December 2008

A 55 year old man with a left ventricular aneurysm, secondary to a previous myocardial infarction, was hospitalized due to a Salmonella virchow bacteraemia. During a 3-week hospital course he was persistently bacteraemic and febrile despite antibiotic treatment. Gallium isotope scanning and 2-D-echocardiography were helpful in demonstrating the presence of an infected false aneurysm at the site of a true aneurysm. Surgical resection in addition to prolonged antibiotic therapy was necessary for cure.
Hyperthyrotrophinaemia during thyroxine replacement therapy
Authors: McClelland P , Stott A , Howel-Evans W
Published: December 2008

During the follow-up of 224 cases of treated hypothyroidism, 14 clinically euthyroid patients were found to have elevated serum thyrotrophin and normal total thyroxine concentrations. Closer observation of these patients during the following 27 months resulted in the serum thyrotrophin levels returning to normal spontaneously in 8 patients (Group 1) whilst remaining elevated in 6 (Group 2), despite no significant differences in thyroid hormone levels between the two groups. Serum thyrotrophin in Group 2 patients remained high until an additional 50 micrograms/day thyroxine was prescribed although only 2 patients noted any benefit. Non-compliance or inadequate dosage of thyroxine are the probable causes of this sub-clinical hypothyroidism. Thyroid hormone estimations fail to differentiate the two conditions and we recommend a period of closer observation before making any thyroxine dosage adjustments in order to detect non-compliance.
Haemophagocytic syndrome complicating acute lymphoblastic leukaemia
Authors: Stark R , Manoharan A
Published: December 2008

A 41 year old female developed reactive haemophagocytic histiocytosis secondary to herpes simplex infection, during remission induction for acute lymphoblastic leukaemia. She recovered fully with acyclovir and supportive treatment. Previous publications on the association between acute lymphoblastic leukaemia and haemophagocytic syndrome are reviewed, and the nature of the haemophagocytic disorder is discussed.
Oesophageal ulcer caused by warfarin
Authors: Loft D E , Stubington S , Clark C , Rees W D
Published: December 2008

Oesophageal injury is a well recognized complication of certain oral medications but warfarin has not been implicated previously. We present a case of an oesophageal ulcer occurring in a patient with mitral regurgitation taking warfarin, and demonstrate a delayed oesophageal tablet transit time.
Foreign body aspiration in the adult: an occult cause of chronic pulmonary symptoms
Authors: Ben-Dov I , Aelony Y
Published: December 2008

We describe two otherwise healthy subjects with many years sequelae due to lung aspiration. In both, diagnosis was delayed due to lack of history of aspiration. Recurrent pneumonia in the same segment in one, and migratory pneumonia in the other, could have suggested the diagnosis.

Review of the literature shows that occult foreign body aspiration poses difficulties in diagnosis and that often a history of aspiration is lacking. However, the recurrent nature and the localization of the pneumonia, as well as the findings during bronchoscopy, should alert the physician to the possibility of foreign body aspiration.
Hypothyroidism and unusual rickets in a very preterm infant
Authors: Macmahon P , Blair M , Kovar I
Published: December 2008

Two separate episodes of rickets developed in a female infant of 25 weeks gestation and birthweight 690 g, who had congenital hypothyroidism and required parenteral nutrition for more than 100 days. We speculate that there is a relationship between metabolic bone disease of prematurity and the preterm infant’s thyroid status.
Catatonia following biparietal infarction with spontaneous recovery
Authors: Howard R J M W , Low-Beer T S
Published: December 2008

We describe a case of catatonic stupor following simultaneous biparietal infarction. The patient recovered, a result not previously described in catatonia caused by this pattern of cerebral infarct.
Severe, self-limiting lactic acidosis and rhabdomyolysis accompanying convulsions
Authors: Winocour P H , Waise A , Young G , Moriarty K J
Published: December 2008

A 26 year old man with no previous history of convulsions presented in status epilepticus and severe lactic acidosis. He regained consciousness and the acidosis resolved after several hours of conservative management without intravenous bicarbonate, but he developed severe myalgia associated with marked elevation of creatine kinase and moderate raised plasma creatinine levels which resolved spontaneously after 3 days.

Severe lactic acidosis and rhabdomyolysis may accompany status epilepticus, although they appear to be self-limiting without important sequelae.
Primary central nervous malignant melanoma in the bathing trunk naevus syndrome
Authors: Salisbury J R , Rose P E
Published: December 2008

The gross and microscopic features of an unusual case of neurocutaneous melanosis are described. This is an example of the rare association between a primary central nervous system malignant melanoma and a giant congenital melanocytic naevus of ‘bathing trunk’ distribution.
Cyclosporin treatment of a woman with acquired haemophilia due to factor VIII:C inhibitor
Authors: Pfliegler G , Boda Z , Hársfalvi J , Flóra-Nagy M , Sári B , Pecze K , Rak K
Published: December 2008

A 47 year old woman is reported who had life-threatening bleeding due to the spontaneous development of factor VIII:C inhibitor. Cyclosporin combined with prednisone resulted in a full recovery and complete elimination of antibody even when other therapeutic facilities failed to be effective.
Asthma in pregnancy complicated by iatrogenic pulmonary oedema
Authors: Hardy C C , Lorigan P , Ratcliffe A , Carroll K B
Published: December 2008

We report a unique case of near fatal acute pulmonary oedema developing with intravenous ritodrine, given in an attempt to suppress premature labour. The novel aspect of the case is that the patient had also been treated in the previous week with high dose nebulized beta-agonists for an episode of acute severe asthma, demonstrating that this idiosyncratic reaction to beta-adrenergic agents only occurs with the intravenous route of administration. The management of acute severe asthma occurring in pregnancy is discussed with a review of previous literature regarding possible mechanisms of beta 2-agonist-induced pulmonary oedema.
Purulent pericarditis
Authors: Hall I P
Published: December 2008

Purulent pericarditis is an infrequent, but important complication of infective illnesses, in particular pneumonia, which if diagnosed early has a good prognosis. The incidence of the condition is probably increasing, particularly in the immuno-compromised group of patients. ‘Classical’ symptoms and signs are often absent, and a high index of awareness is required to diagnose the condition. This review deals with the epidemiology, microbiology, clinical features, treatment and prognosis of purulent pericarditis with two illustrative examples of typical cases.
Cardiac arrhythmias during acute exacerbations of chronic airflow limitation: effect of fall in plasma potassium concentration induced by nebulised beta 2-agonist therapy
Authors: Lim R , Walshaw M J , Saltissi S , Hind C R K
Published: December 2008

The effect on cardiac rhythm of the fall in plasma potassium concentration induced by nebulised beta2-agonist therapy was studied in 20 patients admitted to hospital with an acute exacerbation of their reversible chronic airflow limitation. Arrhythmias considered serious or potentially life-threatening were recorded in 13 patients (65%). However, there was no significant increase in these arrhythmias in the hour following administration of nebulised beta2-agonist despite a significant fall in plasma potassium concentration during this period.
Thrombocytopenia--radial aplasia (TAR) syndrome with associated immune thrombocytopenia
Authors: O’Flanagan S J , Cunningham J M , McManus S , Otridge B W , McManus F
Published: December 2008

We report a 10 year old girl with congenital thrombocytopenia with absent radii (TAR) syndrome. Unusually this patient has shown no abnormal bleeding tendency despite numerous orthopaedic procedures. There is evidence of an associated immune component to the thrombocytopenia which has not been previously documented.
Spontaneous resolution of cervical spinal epidural haematoma
Authors: Anderson T J , Donaldson I MacG
Published: December 2008

A patient with a spontaneous cervical spinal epidural haematoma is described. Surgical decompression is generally regarded as mandatory. There was complete clinical and radiological resolution with non-operative treatment. This is the fifth recorded case of spontaneous resolution of spinal epidural haematoma. In selected patients with incomplete and non-progressing deficit, conservative management may be possible.
Microscopic polyarteritis: clinical features and treatment
Authors: Rodgers H , Guthrie J A , Brownjohn A M , Turney J H
Published: December 2008

The clinical features, treatment and survival of 36 patients with microscopic polyarteritis diagnosed between 1957-1988 have been reviewed. All had a focal segmental necrotizing glomerulonephritis on renal biopsy with evidence of a small vessel vasculitis. Most had a prodromal illness of less than 1 month. Severity of renal disease varied from microscopic haematuria which has a good prognosis to acute oliguric renal failure which carries a high mortality. The prognosis of microscopic polyarteritis can be improved if the condition is recognized early and treated with steroids and cyclophosphamide.
Combined anti-arrhythmic therapy with class 1 and class 3 drugs
Authors: James M A , Papouchado P , Jones J V
Published: December 2008

This study was designed to investigate the differences in efficacy between 3 different combinations of amiodarone and a class 1 anti-arrhythmic drug (one from each class). The purpose was to determine whether the known differing electrophysiological properties of class 1 drugs result in any particular one making a superior combination with the class 3 drug amiodarone. Eight patients were studied in a randomized single blind cross-over trial. Amiodarone and flecainide proved to be the superior combination producing a significantly greater reduction in mean ectopic counts/24 hours than the amiodarone/mexilitene combination (1,286 vs 3,243; P less than 0.05) or the amiodarone/disopyramide combination (3,795; P less than 0.05). All 3 combinations reduced mean ectopic counts from the baseline value (8,729), but this was only significant for amiodarone/flecainide (P less than 0.01) and amiodarone/mexilitene (P less than 0.05). In addition the amiodarone/flecainide combination produced a significant reduction in complex forms of arrhythmia with ventricular tachycardia abolished in all cases, which was not achieved by any other combination.
Psychiatric morbidity in primary hyperparathyroidism
Authors: McAllion S J , Paterson C R
Published: December 2008

Psychiatric symptoms are well recognized as a feature of patients with primary hyperparathyroidism. We have applied a standardized psychiatric interview to 15 patients before and after surgery. Thirteen had a lower ‘psychiatric score’ (less psychiatric morbidity) after surgery and improvements were particularly seen in symptoms of fatigue, depression, irritability, sleep disturbance and lack of concentration. The levels of intellectual impairment and of anxiety were unchanged after surgery. The ‘psychiatric scores’ in an additional group of 21 hyperparathyroid patients, in whom a decision to treat conservatively had been made independently, were similar to those in the surgically treated patients after surgery. Among all the untreated patients no relationship was found between overall ‘psychiatric score’ and serum levels of calcium or parathyrin.
Coexistent Crohn’s disease and sigmoid diverticulosis
Authors: McCue J , Coppen M J , Rasbridge S A , Lock M R
Published: December 2008

This study reports six patients with a diagnosis of diverticular disease with associated localized Crohn’s colitis who were all treated by segmental resection. Two patients died in the post-operative period from disease unrelated to their colonic pathology. The remaining four patients remain well, show no signs of recurrent disease and have required no further surgery. The behaviour and significance of the two conditions occurring in the same patient is discussed.
Bilateral adrenal lymphoma presenting as Addison’s disease
Authors: Pagliuca A , Gillett D S , Salisbury J R , Basu R N , Mufti G J
Published: December 2008

We describe an unusual case of non-Hodgkin’s lymphoma of the adrenals which presented as Addison’s disease. Examination of tissue taken by computed tomography guided biopsy revealed a high grade B cell centroblastic lymphoma. The patient was treated with chemotherapy but died from invasive aspergillosis. Autopsy confirmed bilateral adrenal involvement by lymphoma.
Testicular cancer in three brothers
Authors: Raina V , Young P T , Soukop M
Published: December 2008

Three of four brothers in a family were diagnosed to have testicular tumour. All brothers were in their twenties at diagnosis and all had malignant teratoma, intermediate. One of the brothers, in addition, had a seminoma on the same side as the teratoma. The cases were unusual as there was no family history of cancer and no congenital abnormalities, such as cryptorchidism. Chromosomal analysis and HLA typing did not help in elucidating the cause of this rare familial occurrence of testicular tumour.
Increasing age, diabetes mellitus and recovery from stroke
Authors: Gray C S , French J M , Bates D , Cartlidge N E F , Venables G S , James O F W
Published: December 2008

In a prospective study of 200 patients with acute stroke, blood glucose and glycated haemoglobin (HbA1) were measured within 72 hours of onset. Unrecognized hyperglycaemia as defined by a raised stable HbA1 more than two s.d. above the mean reference value and no previous history of diabetes was present in 27%. No correlation existed between patient age and admission blood glucose or HbA1 levels (r = 0.1).

Cumulative mortality and recovery of limb function was assessed in the first 136 patients with carotid distribution events. Admission blood glucose greater than or equal to 8 mmol/l was shown to be associated with a significantly greater mortality at 4 and 12 weeks (P less than 0.05). Multivariate analysis with age, glucose, HbA1 as independent variables demonstrated that age was the only significant predictor for death at 4 weeks (P less than 0.05) but at 12 weeks both age and blood glucose were significant (P less than 0.05). In patients less than 65 years blood glucose was a significant predictor for death (P less than 0.05) but in patients less than or equal to 65 years HbA1 and not glucose was significantly (P less than 0.05). Patients greater than or equal to 65 years with HbA1 greater than or equal to 7.5% were significantly more likely to have a raised admission blood glucose. Hyperglycaemia on admission was not shown to influence recovery of limb function.

Increasing age is of greatest importance in predicting mortality although blood glucose is of prognostic value especially in the young stroke patient.
Basosquamous carcinoma, a wolf in sheep’s clothing? Report of 3 cases
Authors: Johnson B F , Moore P J , Goepel J R , Slater D N
Published: December 2008

Basosquamous carcinoma of the skin is a lesion with specific histological features and recognized metastatic potential. Three cases of metastatic basosquamous carcinoma are reported, two of which were rapidly fatal. They illustrate that diagnostic features may be absent in a small biopsy and that metastasis is usually associated with a poor prognosis.
Mondor’s disease associated with metastatic lung cancer in the breast
Authors: Courtney S P , Polacarz S , Raftery A T
Published: December 2008

We report what we believe is the first recorded case of Mondor’s disease associated with metastatic lung cancer presenting in the breast. An association between Mondor’s disease and primary breast cancer has been described previously. In patients with Mondor’s disease and primary breast cancer has been described previously. In patients with Mondor’s disease the possibility of underlying carcinoma, either primary or secondary, must be considered.
Red cell folate concentrations in patients with Crohn’s disease on parenteral nutrition
Authors: Tominaga M , Iida M , Aoyagi K , Kohrogi N , Matsui T , Fujishima M
Published: December 2008

To examine changes in the folate concentrations in red cell during relatively long-term total parenteral nutrition (TPN), 10 Japanese patients with Crohn’s disease (7 males), the mean Crohn’s disease activity index on admission being 211, were given folic acid in a dose of 400 micrograms/day (AMA-FDA formulation) or 800 micrograms/day for 6-16 weeks (mean 10.5). The red cell folate concentrations were determined before TPN and once every week or 2-4 weeks thereafter. The folate concentrations were very low even after TPN with folic acid of 400 micrograms/day. In those given 800 micrograms of daily folic acid, the folate levels tended to increase, but did not reach the normal range. We propose that folic acid over 800 micrograms/day or a double dose of AMA-FDA formulation should be prescribed for Crohn’s disease treated with long-term TPN.
Non-steroidal anti-inflammatory drug ingestion: retrospective study of 272 bleeding or perforated peptic ulcers
Authors: Smedley F H , Taube M , Leach R , Wastell C
Published: December 2008

The ingestion of non-steroidal anti-inflammatory drugs (NSAID) in 272 patients with bleeding or perforated peptic ulcer was compared with 272 age/sex matched controls. A significantly higher proportion of patients with gastric ulcers had received NSAID than those with duodenal ulcers.

Twelve of 90 (13%) patients admitted with bleeding duodenal ulcers had received NSAID compared with 11 of 26 (42%) patients with bleeding gastric ulcers (P = 0.003). Sixteen of 132 (12%) patients with perforated duodenal ulcer were taking NSAID compared with 8 of 24 (33%) patients with perforated gastric ulcer. Thirty eight percent of patients with both bleeding and perforated gastric ulcers had received NSAID compared with 13% bleeding and perforated duodenal ulcers (P less than 0.002).

This study confirms the association of NSAID and complicated peptic ulcer in patients of over 65 years and highlights the particular susceptibility of the gastric mucosa to their injurious effect.
Intractable hiccups--an early feature of Addison’s disease
Authors: Hardo P G
Published: December 2008

Hiccups has not been previously reported as a manifestation of Addison’s disease. We report two cases where persistent hiccups was an early feature of Addison’s disease. Steroid replacement cured the symptoms in both patients with no recurrence.
Ventricular fibrillation due to lithium withdrawal--an interaction with chlorpromazine?
Authors: Stevenson R N , Blanshard C , Patterson D L H
Published: December 2008

We report a case of primary ventricular fibrillation following withdrawal of lithium in a patient concurrently taking chlorpromazine. A potentially important drug interaction is discussed.
Life-threatening acute hyponatraemia induced by low dose cyclophosphamide and indomethacin
Authors: Webberley M J , Murray J A
Published: December 2008

We report the case of a patient with multiple myeloma who developed acute life-threatening water intoxication following treatment with oral indomethacin and low dose intravenous cyclophosphamide. We describe a possible drug interaction between these two drugs and recommend that they should only be used together with caution.
Calcific constrictive pericarditis due to rheumatoid arthritis
Authors: Manji H , Raven P
Published: December 2008

A patient with calcific constrictive pericarditis due to rheumatoid arthritis is presented: the literature reveals only one previous case which was attributed to the long duration of the rheumatoid arthritis.
Pyloric obstruction due to gastric tuberculosis—an endoscopic diagnosis
Authors: Gupta B , Mathew S , Bhalla S
Published: December 2008

A 22 year old male presented with symptoms of gastric outlet obstruction. Endoscopy showed a hypertrophic nodular lesion around the pyloric opening with pyloric stenosis. The endoscopic biopsy and histopathological examination revealed tuberculosis involving the stomach, an extremely rare lesion.
Transtelephonic electrocardiographic monitoring for detection and treatment of cardiac arrhythmia
Authors: Safe A F , Maxwell R T
Published: December 2008

Published data on the use of transtelephonic electrocardiographic monitoring for evaluation of episodic symptoms suggestive of cardiac arrhythmia are sparse and conflicting. We have reviewed the use of one such device ‘Cardiomemo’ on our unit over an 18 month period. The study showed that transtelephonic electrocardiographic monitoring is useful in documentation of infrequent or sporadic episodes directly related to symptoms when 24-hour ambulatory electrocardiograph monitoring is normal.
How much can elderly patients tell us about their medications?
Authors: Al Mahdy H , Seymour D G
Published: December 2008

Two hundred and sixty one patients attending a geriatric service were asked to give details of their usual medications without reference to drug bottles or written lists. Recall was tested in 4 categories: name of drugs, drug dosage, frequency of administration, and reason for the drug being prescribed. Drug recall was poor in all 4 categories, but particularly in respect of drug naming where only 10% of patients were able to give a complete list of their drugs. Out-patients were more knowledgeable about their medications than day hospital patients or inpatients. The rate of errors and omissions was correlated with increasing age, decreasing mental score, and to a lesser extent, number of drugs prescribed. Sixty-four percent of patients administered their own medications at home, and their ability to recall their medications was superior to that of other patients. The implications of the above findings are discussed.
Hyperthyroidism during pregnancy due to coexistence of struma ovarii and Graves' disease
Authors: Kung A W C , Ma J T C , Wang C , Young R T
Published: December 2008

A patient with hyperthyroid Graves' disease and struma ovarii is described. She had pre-existing Graves' disease and positive thyrotrophin receptor antibody. She was treated with radioactive iodine 5 months before she became pregnant. Paripartum she had torsion of an ovarian cyst with histological evidence of a functional struma ovarii. Immediate exacerbation of her thyrotoxic state was observed after operation as a result of release of thyroid hormone from the tumour. It is postulated that the tumour was stimulated by circulating thyrotrophin receptor antibody.