bluuebunny/crossref_metadata_2025 huggingface dataset:
Achalasia-like disturbance of oesophageal motility following truncal vagotomy and antrectomy
Authors: Greatorex R A , Thorpe J A C
Published: December 2008

This report describes a patient who developed radiological and manometric evidence of an achalasia-like disturbance of oesophageal motility following transabdominal truncal vagotomy and antrectomy. The patient presented with severe dysphagia which spontaneously resolved after 8 weeks. Subsequent barium swallow and oesophageal manometry demonstrated a return to normal function.
Sarcoid-like lymphadenopathy in malignant teratoma
Authors: O’Connell M , Powell S , Horwich A
Published: December 2008

The reported association between sarcoidosis and malignancy has relevance both to the diagnosis of the cause of lymphadenopathy and possibly also to the prognosis of the malignant disease. A case is reported in which mediastinal lymphadenopathy due to non-caseating epithelioid granulomata caused diagnostic difficulty in the staging investigation of a patient with malignant testicular teratoma.
Ranitidine compared with cimetidine in the short-term healing of duodenal ulcer
Authors: Lee F I , Fielding J D , Costello F T
Published: December 2008

The efficacy of ranitidine (150 mg twice daily) and cimetidine (200 mg three times daily and 400 mg at night) in the short-term healing of duodenal ulcer has been assessed in a randomized controlled trial involving 106 patients. There were 3 drop-outs. Forty-two out of 53 patients (79%) treated with ranitidine had healed ulcers at 4 weeks compared with 37 out of 50 treated with cimetidine (74%). This difference is not significant. At 8 weeks the healing rate for ranitidine (98%) was significantly greater than that for cimetidine (86%) (P less than 0.05). There was no significant difference in healing rates between men and women and between smokers and non-smokers. Side effects were not a problem with either drug. There were no differences of clinical significance between laboratory values in the two treatment groups, although a minor increase in mean creatinine levels occurred in the cimetidine-treated group.
Endomyocardial fibrosis in Africa
Authors: Falase A O
Published: December 2008

Endomyocardial fibrosis (EMF) is a disease of the rain-forest belt in Africa. There is general agreement as to its pathology in the acute phase, but this is difficult to diagnose clinically. The aetiology is still unknown although there are reports which suggest that eosinophilic endomyocardial disease may be the cause. Further studies are needed to define EMF in its acute stage and find out how chronic EMF evolves. A longitudinal study on young people with eosinophilia and a comparative study of two villages, one in an endemic zone and the other in a zone where EMF is uncommon, will also be helpful in identifying its cause. The most promising form of treatment at present is surgical.
A comparison of the clinical and cardiological features of endomyocardial disease in temperate and tropical regions
Authors: Davies J , Spry C J F , Vijayaraghavan G , De Souza J A
Published: December 2008

This study was designed to compare the clinical and cardiological features of endomyocardial disease in temperate and tropical regions. Eleven patients were studied in the U.K., 47 in India and 8 in Brazil. The patients in the U.K. were older, with a male predominance, and they had a systemic illness: the hypereosinophilic syndrome. Half of these patients presented in the early necrotic stage of the disease, and all had biventricular involvement. On the other hand, patients in the tropical countries were younger, with an equal sex incidence, and were from poor, malnourished communities with heavy parasite loads, especially filariasis in India. None presented in the early necrotic stage of the disease and a quarter had isolated right or left ventricular disease.

In order to account for these differences between patients in temperate and tropical regions with endomyocardial disease, it was proposed that the nature of the underlying disease and the rate at which endomyocardial lesions develop, determine the clinical features of this disorder. In temperate climates eosinophil granule toxins may produce a rapidly progressive form of the disease in patients with the hypereosinophilic syndrome, whereas the disease may take longer to develop in patients in tropical climates, who have a less marked eosinophilia due to parasitic infections.
Gastrointestinal haemorrhage from leiomyomata of the small bowel
Authors: Pang J , Jessop J
Published: December 2008

Three cases of haemorrhage from small bowel leiomyomata are reported. The features and management of this rare, but important cause of life-threatening gastrointestinal bleeding, are discussed.
Ventricular fibrillation and initial plasma potassium in acute myocardial infarction
Authors: Thomas Roderic D
Published: December 2008

In a retrospective review of patients admitted to a coronary care unit, 809 patients had a definite myocardial infarction and plasma potassium was measured within 48 hr. The mean (+/- s.d.) plasma potassium was 4.04 (+/- 0.56) mmol/litre. A potassium concentration of less than 4.0 mmol/litre was found in 383 patients, of whom 14 had ventricular fibrillation. A potassium concentration of 4.0 mmol/litre or greater was found in 426 patients, of whom 3 had ventricular fibrillation, a difference significant at the 0.4% level (chi 2 test). Preceding diuretic therapy did not appear to be relevant and there appeared to be no other difference between the two groups. The maintenance of a high-normal plasma potassium, or the prevention of its reduction, in patients with an acute myocardial infarction may be important.
Splenic abscess: successful non-surgical therapy
Authors: Jolobe O M P , Melnick S C
Published: December 2008

A 57-year-old man with splenic abscess, demonstrated by isotope scanning, ultrasonography and computerized axial tomography (CAT scan) during the course of a septicaemic illness resulting from culture-positive bacterial endocarditis, was successfully treated with antibiotics alone, resolution of the abscess being confirmed by 2 further scans. This is the second case report of successful conservative treatment of splenic abscess.
A case of vesical leiomyoma and acute urinary obstruction
Authors: Foster M E , Rees R W M
Published: December 2008

A case of acute urinary retention due to a vesical leiomyoma is described. This is an unusual presentation and the treatment is discussed.
Renal elimination of amiodarone and its desethyl metabolite
Authors: Harris L , Hind C R K , McKenna W J , Savage C , Krikler S J , Storey G C A , Holt D W
Published: December 2008

Two patients in chronic renal failure receiving amiodarone for the treatment of refractory arrhythmias were commenced on dialysis, in one case, intermittent peritoneal dialysis, in the other, haemodialysis. Plasma concentrations of amiodarone and its desethyl metabolite were consistent with the dose received, whilst neither compound was recovered in the dialysate. In these patients and in 10 additional patients with normal renal function taking amiodarone, only negligible amounts of either compound were detected in urine. These findings suggest that amiodarone may be a suitable antiarrhythmic agent for use in patients with chronic renal failure.
The antemortem diagnosis of pyogenic liver abscess due to perforation of the gut by a foreign body
Authors: Shaw Pamela J , Freeman J G
Published: December 2008

Perforation of the gastrointestinal tract by ingested foreign bodies is rare; the diagnosis of pyogenic liver abscess resulting from such perforations is usually made at post-mortem. We present a case of perforation of the gut, due to an ingested dental plate, with a resultant pyogenic liver abscess, which presented as a pyrexia of unknown origin.
Cetrimide burn in an infant
Authors: Mercer D M
Published: December 2008

A case of chemical burns due to cetrimide applied to the nappy area of an infant is recorded.
Depression after stroke: a hospital treatment survey
Authors: Lim M L , Ebrahim S B J
Published: December 2008

Treatment with anti-depressant drugs of 61 inpatients admitted on account of stroke was studied. Eighteen patients (30%) were being so treated. Only 5 patients (17%) with dysphasia were being treated with anti-depressant drugs compared with 13 patients (41%) without dysphasia (P less than 0.05). Dosage levels used were generally low and only one patient had been referred for a psychiatric opinion. We suggest that the difference in anti-depressant usage is because dysphasic patients are more difficult to assess and therefore less likely to have depressive symptoms recognized and treatment given. We also think that psychiatric referral should be used more often for assessment of stroke patients and for advice about treatment.
Chlorpromazine, placebo and droperidol in the treatment of nausea and vomiting associated with cisplatin therapy
Authors: Stuart-Harris R , Buckman R , Starke I , Wiltshaw Eve
Published: December 2008

The use of cisplatin may be associated with severe nausea and vomiting. Two separate, randomized, double-blind trials, comparing the anti-emetic effect of chlorpromazine with placebo and chlorpromazine with droperidol, were conducted in patients receiving cisplatin for ovarian cancer. Chlorpromazine was statistically superior to placebo in the control of nausea and vomiting in those patients treated with chlorpromazine had significantly less nausea than with droperidol, but there were no other significant differences between chlorpromazine and droperidol. Toxicities of chlorpromazine and droperidol were similar. Chlorpromazine shows useful activity against cisplatin nausea and vomiting.
Guillain-Barré syndrome associated with tuberculosis
Authors: Vyravanathan S , Senanayake N
Published: December 2008

Two cases of Guillain-Barré syndrome occurring in association with chronic pulmonary tuberculosis are reported. A cell-mediated, delayed hypersensitivity reaction to, or invasion of the nerve roots by tubercle bacilli would seem to be the likely explanation of the neuropathy.
Stridor and parkinsonism
Authors: Read David , Young Alastair
Published: December 2008

A patient is described with idiopathic Parkinson’s disease and severe laryngeal stridor. Other than urinary frequency and urgency, not uncommon in this condition, and postoperative levodopa-sensitive postural hypotension, there were no features of generalized autonomic failure. The laryngeal stridor responded to levodopa therapy, and we are not aware that this has been reported previously.
An unusually severe case of the cast syndrome
Authors: Kennedy R H , Cooper M J
Published: December 2008

A severe case of the cast syndrome is described following Harrington rod distraction and application of a body cast. The case was unusual as it presented late with no warning symptoms and progressed rapidly to death.
Experience of temporary cardiac pacing in a district general hospital
Authors: Paterson Kenneth R
Published: December 2008

Temporary cardiac pacing is widely used in the management of dysrhythmias; increasingly it is being employed in district general hospitals without specialist cardiology facilities. A retrospective study of 117 pacing procedures in a district hospital has shown that temporary pacing is both safe and effective and supports its more widespread use.
Unrecognised nocturnal hypoglycaemia masquerading as senile dementia
Authors: Ramasamy R
Published: December 2008

A 70-year-old woman with insulin dependent diabetes mellitus presented with symptoms suggestive of senile dementia. Outpatient assessment failed to reveal poor diabetic control with frequent nocturnal hypoglycaemia. Eventual appreciation of the poor control resulted in several failed attempts at improving therapy with various subcutaneous insulin regimes. Intramuscular and intravenous routes produced acceptable blood glucose levels with striking reversal of the patient’s symptoms. The possible causes of nocturnal hypoglycaemia in this patient are discussed.
Blood pressure in 15- to 16-year-old adolescents of different ethnic groups in two London schools
Authors: Khaw Kay-Tee , Marmot M G
Published: December 2008

A blood pressure screening survey was conducted in 357 students, aged 15-16 years, in 2 London schools. Males had higher systolic blood pressures than females, and white males had significantly higher mean systolic pressures than black males, but diastolic pressures were similar. There is no evidence in this survey that blacks have higher mean blood pressures than whites—rather the reverse. This and the difference in blood pressure between schools suggest environmental factors may be important determinants of blood pressure.
Thoughts on the aetiology of vitamin D deficiency in Asians
Authors: Heath D A
Published: December 2008

Following the virtual elimination of vitamin D deficiency in Britain earlier this century, rickets and osteomalacia began to be recognized with increasing frequency in the early sixties (Dunnigan et al., 1962). The disease was almost entirely restricted to Asian subjects and was subsequently reported in all cities having a significant Asian population. The purpose of this review is to point out that most current theories not only fail to explain the occurrence of vitamin D deficiency in Asians, but also cannot adequately explain the deficiency occurring in liver and gastrointestinal disorders. A theory is put forward that more completely encompasses the known facts.
Leprosy in Birmingham—a review
Authors: Ellis C J
Published: December 2008

Twenty-three men and seven women from the West Midlands conurbation (population 2.7 million) have been investigated and treated for leprosy since 1970. The clinical features of the patients at presentation are described with an account of treatment given and the outcome. The pattern of this disease in Britain is different from that seen in the U.S.A. and poses little threat to public health. The disease can be cured by chemotherapy but neuropathy is unlikely to recover if it is a presenting symptom. The diagnosis of leprosy should be considered in all patients who have lived in an endemic area who present with disorders of peripheral nerves or skin. Early diagnosis is essential to minimize nerve damage and resulting deformity.
Ethnic differences in birthweight-related parameters with particular reference to possible maternal nutritional risk factors
Authors: Condie R G , Terry P B
Published: December 2008

Three birthweight-related parameters were examined in the deliveries occurring from January to July 1982 at Dudley Road Hospital, Birmingham, in 3 major ethnic groups and in relation to possible maternal nutritional risk factors in the European and Indian groups. Ponderal index did not correlate with either mean or ‘corrected’ birthweight especially in the West Indians.

The 3 maternal nutritional risk factors appeared to be of greater fetal prognostic value in the Indian group than in the European group.
Ethnicity, self-reported illness and use of medical services by the elderly
Authors: Blakemore K
Published: December 2008

Analysis of ethnic differences in disease is complicated by the fact that culture has an effect on whether people identify themselves as ill and how often they use medical services. This paper cities evidence to show that use of selected medical services by older members of ethnic groups appears to be high. Although a relatively high amount of disease among minority ethnic groups partly accounts for this, additional explanations—notably, cultural perceptions of doctors and aspects of the ageing migrant’s position in society—are suggested.
Familial venous thrombosis
Authors: Winter J H , Douglas A S
Published: December 2008

It is not uncommon for a patient presenting with deep venous thrombosis or pulmonary embolism to describe the occurrence of such disease in members of his or her family. The occasional familial clustering of venous thromboembolic disease has been recognized for many years; for example, Briggs in 1905 states: ‘The patient, a man of 35 years, has since 1887 passed through 8 attacks of thrombophlebitis in the lower extremities… Of 16 adult individuals among this gentleman’s ancestors and collateral relatives, 8 have shown a marked susceptibility to venous disease, in the manifestation of varices and haemorrhoids or in extreme liability of thrombosis in the puerperium or following acute infections’.
Corticosteroids in terminal cancer—a prospective analysis of current practice
Authors: Hanks G W , Trueman T , Twycross R G
Published: December 2008

Over half of a group of 373 inpatients with advanced malignant disease were treated with corticosteroids for a variety of reasons. They received either prednisolone or dexamethasone, or replacement therapy with cortisone acetate. Forty percent of those receiving corticosteroids benefited from them. A higher response rate was seen when corticosteroids were prescribed for nerve compression pain, for raised intracranial pressure, and when used in conjunction with chemotherapy. No significant difference in efficacy was noted between the 2 drugs. The results, however, suggest that with a larger sample, dexamethasone would have been shown to be significantly better than prednisolone in the management of nerve compression pain.

The incidence of side effects was broadly similar with dexamethasone and prednisolone. The most common side effect was oral candidosis and there was a highly significant relationship between the use of corticosteroids and the prescription of nystatin suspension. Dexamethasone was more likely than prednisolone to cause oro-pharyngeal candidosis. Dexamethasone was also associated with significantly more cases of psychological disturbance and hyperactivity. On the other hand, dexamethasone seems less likely to cause oedema, weight gain and dyspepsia. Corticosteroids were withdrawn because of side effects in only 11 patients (5%)—6 were receiving dexamethasone and 5 prednisolone. Dexamethasone has been adopted as the standard corticosteroid for terminal cancer patients at Sir Michael Sobell House.
Immune complex glomerulonephritis and chronic anaerobic urinary infection—complications of filariasis
Authors: Ormerod A D , Petersen J , Hussey J K , Weir J , Edward N
Published: December 2008

We describe a patient with chyluria due to abdominal Bancroftian filariasis. The patient showed two unusual complications, an immune complex glomerulonephritis and a chronic urinary infection. We also discuss the use of the CT whole body scanner in the diagnosis and delineation of the extent of the disease.
Value of profiling liver function in the elderly
Authors: Lubin J R , Coles J A , Millward B A , Croker J R
Published: December 2008

The value of measuring three routine tests of liver function was assessed prospectively in 523 geriatric patients. Abnormalities were found in 27% of patients and were clinically helpful in half of these cases. Profiling liver function, without clinical indication, revealed abnormal results in 17% of patients and was important in one-third of these (6% of total). The two most important diagnoses were unsuspected osteomalacia and gall stone disease.
Nocturnal nasogastric tube feeding at home
Authors: McIntyre P B , Wood S R , Powell-Tuck J , Lennard-Jones J E
Published: December 2008

Five malnourished patients who consistently failed to maintain or gain weight with other oral diets have been taught to give themselves a nocturnal nasogastric tube feed at home to supplement their dietary intake by day. All patients gained weight at a rate of about 0.5 kg per week. Nasogastric tube feeding at home can be an acceptable, safe, economical and efficient treatment for nutritional depletion, particularly in patients with a short functional length of small intestine for whom simpler dietary manipulation has been unsuccessful.
Peripartum cardiomyopathy in a patient with hyperprolactinaemia
Authors: Matharu G. S. , Oelbaum M. H.
Published: December 2008

The clinical course of a patient with peripartum cardiomyopathy and hyperprolactinaemia is described. Hyperprolactinaemia may be a factor in this patient’s heart failure.
Urinary iron loss in the nephrotic syndrome—an unusual cause of iron deficiency with a note on urinary copper losses
Authors: Brown E. A. , Sampson B. , Muller B. R. , Curtis J. R.
Published: December 2008

Two patients with long-standing nephrotic syndrome are described in whom urinary iron losses may have contributed towards an iron deficiency state. Seven other nephrotic patients were also studied. Increased urinary iron excretion was found in six out of nine patients and increased urinary copper excretion in all eight patients in whom it was measured. Trace metal losses in the urine in nephrotics may be important clinically.
Reversibility of alcoholic cardiomyopathy
Authors: Kupari Markku
Published: December 2008

A patient with alcoholic cardiomyopathy is described in whom cardiovascular function capacity and radiological heart size fluctuated widely with periods of heavy drinking and abstinence. On two occasions, cessation of drinking resulted in clinical recovery from severe degrees of congestive failure and in complete reversal of cardiac enlargement. Echocardiographic follow-up showed, however, that the true rapidity of myocardial recovery was much slower than estimated clinically and radiologically and than suggested by the previous reports.
Progressive multifocal leukoencephalopathy, myelodysplastic syndrome type II and prostatic carcinoma
Authors: Barber P. , Gorst D. W. , Morris J. A. , Pearson J. D.
Published: December 2008

A case is described of progressive multifocal leukoencephalopathy (PML) occurring in a man with myelodysplastic syndrome type II (MDS II) and prostatic carcinoma. This is the first case, to our knowledge, of the association of PML with MDS II.
Osteosarcoma of breast recurring with mediastinal obstruction
Authors: Hutton C. W. , Strang C.
Published: December 2008

A case of osteogenic sarcoma of the breast in an 82-year-old woman is described. It was treated by simple mastectomy but recurred and caused mediastinal obstruction. Radiotherapy gave only mild symptomatic benefit. Previous publications in osteosarcoma of the breast are reviewed.
Pre-operative mediastinal evaluation in primary bronchial carcinoma—a review of staging investigations
Authors: Elliott John A.
Published: December 2008

A review of staging investigations in the preoperative evaluation of mediastinal involvement in primary bronchial carcinoma is presented.

The following conclusions are offered as guidelines for the use of mediastinal staging procedures in clinical practice:

Surgical staging methods have the over-riding advantage of superior specificity over indirect imaging techniques. Where 67Ga-imaging or CT scanning are not available, routine pre-operative mediastinoscopy or, when appropriate, mediastinotomy will identify most patients with non-resectable disease but this approach entails a high proportion of true negative examinations.

Radioisotope ventilation and perfusion lung imaging has no place in the pre-operative staging of lung cancer.

Where the techniques are available, 67Ga-imaging and CT scanning have a use in selecting patients for mediastinal exploration.

A negative mediastinal 67Ga scan or a negative CT examination suggest that mediastinal exploration will be unrewarding in the vast majority of cases and may be omitted prior to thoracotomy.

A positive mediastinal 67Ga scan or the demonstration of abnormal mediastinal nodes by CT is an indication for mediastinal exploration which, if negative should be followed by thoracotomy.
Serum angiotensin converting enzyme in Sjogren’s syndrome—a case report and study of 21 further cases
Authors: Machin N. Dianne , Chard Michael D. , Paice E. W.
Published: December 2008

We report the case of an elderly woman with primary Sjogren’s syndrome and abnormal liver function tests indicative of primary biliary cirrhosis. She was found to have a raised serum angiotensin converting enzyme activity. We proceeded to study 21 further cases of Sjogren’s syndrome to discover whether raised levels of this enzyme were a feature of Sjogren’s syndrome. None of them had any features to suggested associated primary biliary cirrhosis. The cases included 12 with associated rheumatoid arthritis, two with systemic sclerosis, three with systemic lupus erythematosus and four with primary Sjogren’s syndrome. In only two of these 21 patients was a raised serum angiotensin converting enzyme obtained, the elevation being modest. We conclude that a raised activity of the enzyme is not usually associated with primary or secondary Sjogren’s syndrome, and that discovery of such an abnormality should prompt a search for an associated condition.
Mastication and acid secretion
Authors: Dubey Pushpa , Nundy S.
Published: December 2008

The gastric acid response and the buffer capacity of the stomach were measured in 30 control subjects and 22 duodenal ulcer patients in response to a masticatory (solid) and a non-masticatory (homogenized) meal having the same chemical composition. The peak acid output values were equal after a masticatory and after a non-masticatory diet in control subjects (masticatory 18.1 ± 1.2, non-masticatory 15.7 ± 1.3 mmol/hr) as well as in duodenal ulcer patients (masticatory 35.7 ± 1.5, non-masticatory 33.7 ± 1.1 mmol/hr). The buffer capacity of the stomach contents 1 hr after the meal was significantly greater after a masticatory diet than a non-masticatory diet in both controls (14.6 ± 1.4 and 9.0 ± 1.9 mmol) and in duodenal ulcer patients (9.5 ± 1.5 and 7.5 ± 1.2 mmol). Duodenal ulcer patients had a significantly lower buffer capacity compared with controls. Masticatory diets may play a part in protecting individuals from developing duodenal ulcer.
Significance of idiopathic deep venous thrombosis
Authors: O’Connor N. T. J. , Cederholm-Williams S. A. , Fletcher E. W. , Allington M. , Sharp A. A.
Published: December 2008

The risk of developing an overt malignancy after an isolated deep venous thrombosis (DVT) is poorly documented. We therefore reviewed a series of patients in whom a solitary idiopathic DVT had been proven by venography at least 12 months earlier. No patient had developed a malignancy at follow-up. However, decreased fibrinolytic activity was observed in five out of the six patients aged less than 45 years. Patients with an idiopathic DVT should not be subjected to an exhaustive search for malignancy.
Hypopituitarism associated with myalgia
Authors: Horowitz M. , Byrne E. , Burnet R.
Published: December 2008

A patient with panhypopituitarism who presented with muscle pain and stiffness is described. These symptoms responded rapidly to treatment with thyroxine and cortisone acetate. The association between muscle disease and hypopituitarism is briefly reviewed.
Dressler’s syndrome after right ventricular infarction
Authors: Streifler Jonathan , Pitlik Silvio , Dux Shlomo , Perry Gershon , Hellman Chaim , Greenwald Mark , Rosenfeld Joseph B.
Published: December 2008

Undiagnosed myocardial infarction of the right ventricle presented as Dressler’s syndrome. Radioisotopic diagnostic procedures including first-pass and multigated acquisition nuclear angiography ( MUGA ) and thallium-201 perfusion studies enabled a retroactive diagnosis of myocardial infarction, showed it to be in the right ventricle, and clarified the aetiology of the unexplained fever and pleuropericarditis.
Persistent akathisia associated with early tardive dyskinesia
Authors: Barnes Thomas R. E. , Braude Walter M.
Published: December 2008

Two psychiatric patients developed moderate or severe oro-facial dyskinesia, and limb dyskinesia, at a relatively young age and within a year of starting antipsychotic drug-treatment. This early appearance of tardive dyskinesia was preceded by akathisia that had developed at the beginning of drug therapy and persisted, despite the reduction of their drug doses to maintenance levels. The possibility that persistent akathisia may herald the early onset of tardive dyskinesia, is discussed.
Hypersensitivity to azathioprine in myasthenia gravis
Authors: Watts G. F. , Corston R.
Published: December 2008

A patient with myasthenia gravis is described who exhibited hypersensitivity including an apparent acute exacerbation of the underlying disorder when treated with azathioprine. 6-mercaptoprine (6-MP) also produced hypersensitivity which, in contrast, did not manifest as a myasthenic exacerbation.
Hyperkalaemia in diabetes mellitus—potential hazards of coexisting hyporeninaemic hypoaldosteronism
Authors: Large D. M. , Carr P. H. , Laing I. , Davies M.
Published: December 2008

Two patients with insulin-dependent diabetes mellitus (Type I), developed severe, life-threatening hyperkalaemia, the first following treatment with spironolactone, the second during treatment for staphylococcal septicaemia when glucose-induced hyperkalaemia occurred. Investigations demonstrated co-existing hyporeininaemic hypoaldosteronism. Prompt recognition of this combined hormone-deficiency syndrome led to appropriate treatment and recovery. The biochemical features and clinical importance of hyporeninaemic hypoaldosteronism are discussed.
Choledochal cysts—report of three cases and review
Authors: Waldron R. , Drumm J. , McCarthy C. F. , Murphy B.
Published: December 2008

Three cases of choledochal cyst are presented, with a review of previous publications. We re-emphasize the diagnostic dilemma involved and discuss current surgical management. A new complication is illustrated and an association with polycystic kidneys is reported.

Choledochal cysts are uncommon, but correct management ensures a symptom-free future for the patient. Recent reports support cyst excision if technically feasible.
Abdominal incisions—vertical or transverse?
Authors: Ellis Harold , Coleridge-Smith Philip D. , Joyce Adrian D.
Published: December 2008

Two-hundred and nine patients were entered into a prospective, randomized trial in order to determine whether a vertical or transverse abdominal incision is the more satisfactory in producing sound wounds. Ninety-six patients were randomized between paramedian and transverse incisions, and followed up for at least 1 year. No significant difference in the incidence of wound failure could be shown between 46 paramedian and 50 transverse incisions. Those patients who were considered to require a vertical incision were randomized between median and paramedian incisions. No significant difference in wound failure rates between 39 median and 40 paramedian incisions could be demonstrated. No advantage or disadvantage of a transverse over a vertical abdominal incision or of a paramedian over a median incision could be shown in this study.
Intracerebral haemorrhage and vasculitis secondary to amphetamine use
Authors: Salanova V. , Taubner R.
Published: December 2008

We report a case of amphetamine-related intracranial haemorrhage and vasculitis, responding to immunosuppressants. Angiograms obtained before and after therapy are shown; the importance of immunosuppressive therapy is discussed.
Paradoxical lipodystrophic changes due to conventional bovine and highly purified porcine/bovine insulins
Authors: Campbell I. W. , Duncan C. , Anani A. R.
Published: December 2008

A 78-year-old woman developed marked insulin lipoatrophy due to conventional bovine insulin injected into the upper limbs. Changing to a combination of highly purified porcine/bovine insulins injected into the lower limbs resulted in the opposite effect, namely insulin-induced lipohypertrophy. Use was then made of this effect by injecting the highly purified insulins into the atrophied upper limb injection sites with resultant improvement in these wasted areas over the next 10 months.
Plasma cholesterol concentration and extra lipid band in monoclonal gammopathies
Authors: Levy Yishai , Aviram Michael , Spira Gad , Tatarsky Ilana , Brook Gerald J. , Carter Anna
Published: December 2008

Plasma lipids and lipoproteins were studied in 21 patients with benign monoclonal gammopathy, 21 patients with multiple myeloma and seven patients with Waldenström’s macroglobulinaemia. Results were compared with those of a control group, age and sex matched. Low plasma cholesterol levels in all three patient groups were associated with low HDL-cholesterol concentrations. Apo A-I, but not apo B, was significantly reduced. Sixty per cent of the patients exhibited an extra lipid band on plasma lipoprotein electrophoresis, which could be an immunoglobulin-lipid complex. In these patients plasma and LDL-cholesterol levels were significantly lower than in those patients in whom this band was absent. No correlation was found between the severity of the disease and plasma lipid pattern.
Acute pancreatitis complicating excessive intake of phenolphthalein
Authors: Lambrianides A. L. , Rosin R. D.
Published: December 2008

A case is described in which a patient presented with acute pancreatitis following inadvertent ingestion of large quantities of phenolphthalein for the treatment of his chronic constipation. There was complete recovery and no sequelae from the acute attack of pancreatitis.
A fatal case of creosote poisoning
Authors: Bowman Clive E. , Muhleman Mark F. , Walters Ewan
Published: December 2008

A case of fatal creosote poisoning is described. On presentation, extensive oropharyngeal ulceration was noted and gastric lavage withheld. Post-mortem examination showed an intact oesophagus and stomach.
Carcinoma of the breast in a male with hypogonadotropic hypogonadism
Authors: Prince R. L.
Published: December 2008

There is an increased risk of development of carcinoma of the breast in males with hypogonadism due to Klinefelter’s syndrome. A patient with isolated hypogonadotropic hypogonadism and gynaecomastia developed an intraduct carcinoma of the breast. This is believed to be the first reported case of this association.
Captopril-induced acute renal artery thrombosis and persistent anuria in a patient with documented pre-existing renal artery stenosis and renal failure
Authors: Williams P. S. , Hendy M. S. , Ackrill P.
Published: December 2008

We describe an elderly man, with pre-existing renal failure and atheromatous renal artery stenosis, who developed persistent anuria due to renal artery thrombosis after acute hypotension following captopril administration. Caution should be used when captopril is first administered to patients with impaired renal function in whom renal artery stenosis is known or suspected.
Tuberculous meningitis in the elderly
Authors: Dixon P. E. , Hoey C. , Cayley A. C. D.
Published: December 2008

Six cases of tuberculous meningitis, all occurring in patients over the age of 65, are described. All patients presented with an acute illness, primarily with a confusional state. Headache was a symptom in only two patients and the cases were not confined to ethnic minority groups. The mortality was 50%.
Acute pancreatitis and Cushing’s syndrome
Authors: Clague H. W. , Warren B. , Krasner N.
Published: December 2008

A case of acute necrotizing pancreatitis in a 53-year-old man with an ectopic adrenocorticotrophin (ACTH) producing bronchial carcinoma is described. The aetiology of acute pancreatitis in relation to steroid therapy and malignancy is discussed and it is suggested that excess endogenous steroid production may also cause acute pancreatitis.
Massive gastric distension in acute pancreatitis—a report of two cases
Authors: Murray W. J. G.
Published: December 2008

Massive gastric distension was diagnosed in 2 patients with acute pancreatitis. Both showed signs of severe peripheral circulatory failure, and responded well to intravenous fluid replacement and nasogastric aspiration. A review of the literature revealed only 2 previously reported cases. The possible mechanisms linking the pathogenesis of these 2 conditions are discussed.
Hyperthyroidism and immune thrombocytopenia
Authors: Jacobs Peter , Majoos Francois , Perrotta Augustine
Published: December 2008

Hyperthyroidism and immune thrombocytopenia occurred concurrently in five patients; in a sixth, thyrotoxicosis developed after successful treatment of the thrombocytopenia. Correction of the hyperthyroidism was followed by a variable pattern of clinical response. In one case with mild asymptomatic thrombocytopenia spontaneous complete remission occurred. Two patients required adrenocorticosteroids to control severe thrombocytopenic purpura during the period of hyperthyroidism, after which complete remission occurred. Another patient with severe symptomatic thrombocytopenia remains with a partially compensated thrombocytolytic state but is without purpura and off all therapy. A fifth patient required splenectomy for drug-resistant thrombocytopenia and remains critically dependent on immunosuppressive therapy. The sixth patient had a relapse of immune thrombocytopenia with subsequent development of thyrotoxicosis but platelet count spontaneously returned to normal after correction of the hyperthyroidism. Pregnancy in two of these six patients was not associated with recurrence of either hyperthyroidism or thrombocytopenia.

Management of symptomatic purpura in adults with co-existent hyperthyroidism may differ from that customarily employed since adrenocorticosteroid therapy may need to be extended until euthyroidism has been established before proceeding to splenectomy. When surgery is necessary, the risk of thyrotoxic storm should be anticipated, and the patient appropriately premedicated.
Myocardial damage due to hypokalaemia and hypophosphataemia
Authors: Frustaci Andrea , Pennestrì Faustino , Scoppetta Ciriaco
Published: December 2008

A case of severe hypokalaemia with stupor, skeletal muscle and heart muscle damage is reported.

An initial infusion of glucose-insulin and potassium (GIK) produced a temporary clinical improvement with reduction of creatine kinase (CKMB) and elevation of serum K+. On the 4th day of treatment, neuromuscular and cardiovascular deterioration occurred accompanied by a further rise of CKMB. This deterioration was coincident with a serum phosphate of 0.26 mmol/l. The impaired left ventricular (LV) function was measured using echocardiography and detecting the ejection fraction (EF).

GIK was stopped and a potassium phosphate infusion commenced. As the phosphate and potassium deficiencies were corrected, the neuromuscular and cardiac abnormalities resolved, CKMB fell to normal and LVEF rose from 40% to 72%.

We suggest that additional cardiac damage due to hypophosphataemia may have occurred in this patient, who already had cardiac impairment as a result of profound hypokalaemia. Possible mechanisms are discussed.
An ulcerated gastric diverticulum—a rare cause of haematemesis and melaena
Authors: Gibbons C. P. , Harvey L.
Published: December 2008

A case of recurrent intraluminal bleeding from an ulcerated gastric diverticulum is described. Difficulties in diagnosis and treatment of this rare condition are discussed. The importance of accurate preoperative diagnosis by endoscopy and barium meal is emphasized.
Probable adverse interaction between oral metoprolol and verapamil
Authors: Eisenberg J. N. , Oakley G. D. G.
Published: December 2008

A combination of an oral beta-adrenergic blocking agent and verapamil has been advocated as a safe treatment for angina. A case of Wenckebach type atrioventricular block occurring in a patient on metoprolol and verapamil is reported. It is suggested that this combination is used with caution.
Fatal neonatal septicaemia and meningitis due to Haemophilus influenzae acquired from the mother
Authors: Chattopadhyay B.
Published: December 2008

A fatal case of neonatal Haemophilus influenzae type b, septicaemia and meningitis is described. Although the mother was asymptomatic, maternal genital tract culture yielded H. influenzae which was indistinguishable from the strain found in the infant. Despite the rarity of this organism as a cause of neonatal sepsis, increased awareness is essential so that this important offending pathogen is not missed.
A clinical comparison of purified bovine and purified porcine insulins
Authors: Olczak S A , Greenwood R H
Published: December 2008

Twenty four patients with established insulin dependent diabetes treated with twice daily soluble and isophane bovine insulins were changed to equivalent doses of either purified bovine Neusulin and Neuphane (Wellcome) or purified porcine Actrapid and Monotard (Novo) insulins. After 6 months treatment the porcine group showed a 35% fall in insulin binding antibodies and a 14% reduction in insulin dosage. The group changed to purified bovine insulins showed no significant change in insulin binding antibodies and no change in insulin dose. Mean blood glucose and glycosylated serum protein fell in both groups during the study period but there was no significant difference between the two groups.
The swollen leg: ultrasonographic demonstration of non-thrombotic causes
Authors: Bell J M , Ross F G M , Mackenzie S , Goddard P R
Published: December 2008

Grey-scale ultrasound is a useful investigation in selected patients with a painful swollen leg. It is of particular value in cases in which there is a clinical suspicion of deep vein thrombosis (DVT) but other features, such as an atypical history or equivocal radiology, suggest alternative pathology. Five such cases are presented in which ultrasound showed transonic lesions. The cause of the swelling of the leg was thus shown to be ‘cystic’ in nature and therefore not due to DVT. This enabled inappropriate and potentially harmful therapy to be avoided and the correct therapy, such as surgical drainage, to be undertaken.
Anorexia nervosa and necrotizing colitis
Authors: Kaye J C , Madden M V , Leaper D J
Published: December 2008

Anorexia nervosa is associated with a mortality approaching 5% in patients severely enough affected to warrant hospital care (Hsu, 1980). The main causes of death are inanition, electrolyte disturbances or suicide. We report here a case of necrotizing colitis associated with anorexia nervosa, an association which has not been described previously.
A mesothelioma presenting with multicentric reticulohistiocytosis
Authors: Honeybourne D , Kellett J K
Published: December 2008

Multicentric reticulohistiocytosis is a rare disorder of the skin and joints, with characteristic histological features. An increasing number of reported cases have been associated with internal malignancy. We report a case of multicentric reticulohistiocytosis in an elderly man with mesothelioma.
Waterhouse-Friderichsen syndrome without purpura due to Haemophilus influenzae group B
Authors: Morrison U , Taylor M , Sheahan D G , Keane C T
Published: December 2008

A second recorded case of Waterhouse-Friderichsen syndrome, without purpura, due to Haemophilus influenzae is described. It is suggested that the absence of purpura should not preclude the diagnosis of the Waterhouse-Friderichsen syndrome due to this organism.
The clinical response to treatment in adult Cushing's syndrome following remission of hypercortisolaemia
Authors: Ross E J , Linch D C
Published: December 2008

The clinical response of 57 adult patients with Cushing's syndrome due to bilateral adrenocortical hyperplasia or adrenocortical adenoma is documented following resolution of hypercortisolaemia by various forms of treatment. Despite satisfactory biochemical remission of the disease the clinical result was far less satisfactory when assessed by persistence of obesity (55%), menstrual irregularity (41%), hypertension (29%) and insulin-dependent diabetes (22%). Myopathy, hirsuitism and psychological abnormalities persisted to a lesser extent. The mortality rate of the series over a 30 year follow-up period was 4 times that of a general population matched for sex, age and year of entry into the series. Cardiovascular disease was the cause of death in 85%. Irreparable cardiovascular disease is produced early in the course of hypercortisolaemia, emphasizing the vital importance of the earliest possible recognition and treatment of this disease.
The use of intravenous meptazinol for analgesia in colonoscopy
Authors: Barnes P R H , Williams C B , Davies R L , Childs C S B , Hedges A , Graham D
Published: December 2008

A double blind study comparing intravenous pethidine and meptazinol has been performed to establish the efficacy and safety of meptazinol as an analgesic agent in colonoscopy. Twenty two patients received pethidine and 23 patients received meptazinol and no difference in analgesic effect or sedative effect could be demonstrated either by observer or patient assessment using a visual analogue scale. A group of 10 patients in the pethidine group and 9 in the meptazinol group had continuous recording of electrocardiogram, pulse rate and blood pressure throughout the procedure. Significant falls in both systolic and diastolic blood pressure were recorded in the pethidine group but not the meptazinol group. Benign cardiac arrhythmias were recorded in both groups before and after the administration of premedicant drug and 1 patient in each group had transient ST depression. Side effects were recorded with equal frequency in each group except for vomiting which occurred in 5 of 23 meptazinol patients but none of the pethidine patients.

Meptazinol is an effective analgesic drug in colonoscopy which produces less cardiovascular depression than pethidine and thus may be useful in selected patients especially the elderly or those with known cardiovascular disease.
Amiodarone-induced vasculitis and polyserositis
Authors: Stäubli M , Zimmermann A , Bircher J
Published: December 2008

A dose-dependent cutaneous leukocytoclastic vasculitis developed in a 34 year old man who was given amiodarone for supraventricular tachycardias resistant to other drugs. This adverse reaction disappeared within 2 weeks after discontinuation of amiodarone despite its very long half-life of 52 days in this patient. During previous treatment periods with amiodarone, the patient had experienced photosensitivity and dose-dependent polyserositis. Since high doses of amiodarone have been recently proposed for the treatment of resistant cardiac arrhythmias, dose-dependent adverse effects as described here may be encountered with increasing frequency.
Pneumatocele formation in a patient with Proteus mirabilis pneumonia
Authors: Lysy J , Werczberger A , Globus M , Chowers I
Published: December 2008

A rare case of pulmonary pneumatoceles complicating the course of Proteus pneumonia in an adult is described. The pneumatoceles which appeared early in the course of the pneumonia resolved completely without complications. A brief review of the literature regarding formation of cavities in Proteus pneumonia is given.
Identical twins with uterus didelphys and duplex kidneys
Authors: Daw E , Toon P
Published: December 2008

Identical twins with uterus didelphys and bilateral duplex kidneys are reported.
The management of liver trauma
Authors: Macfarlane R
Published: December 2008

Despite advances in the management of liver trauma during the past 40 years, haemorrhage has remained the commonest cause of death. This article outlines the diversity of opinion between the desire to determine the extent of damage and resect devitalised tissue with its attendant risk of exacerbating haemorrhage, and the alternative of a more conservative approach.
Pacemaker discomfort induced by the wearing of seat belts
Authors: Wallis M , Todd I , Aber C P
Published: December 2008

A survey was made of 100 consecutive pacemaker recipients to examine problems they may have experienced with seat belts whilst travelling by car, either as drivers (29 patients) or front seat passengers (50 patients). Twenty-one per cent of the drivers and 30% of the front seat passengers had experienced symptoms, usually of a mild nature. Re-siting of the generator was only necessary in 1 patient and no example of electrode displacement was observed. Suggestions are made as to how this problem might be overcome.
Cerebral systemic lupus erythematosus presenting with catatonia
Authors: Lanham J G , Brown M M , Hughes G R V
Published: December 2008

A 13 year old girl with catatonia resulting from cerebral lupus is described. She had concurrent minor epileptic status, but abolition of her seizure activity failed to influence her catatonic state. She recovered after treatment with corticosteroids and immunosuppressive agents. Cerebral lupus should be considered in the differential diagnosis in patients presenting with catatonia.