bluuebunny/crossref_metadata_2025 huggingface dataset:
Disseminated aspergillosis following radiation therapy for medulloblastoma
Authors: Hamilton P , Darbyshire P J , McKeever P , Oakhill A
Published: December 2008

A 16 year old girl who underwent surgery and radiotherapy for medulloblastoma is described. Shortly following the completion of treatment symptoms developed suggestive of tumour recurrence. At post mortem the cause was identified as disseminated aspergillosis with extensive cerebral involvement. The importance of this unusual complication is discussed.
Familial bilateral multiple fibroadenomas of the breast
Authors: Naraynsingh V , Raju G C
Published: December 2008

This paper describes multiple breast fibroadenomas in three siblings. It appears that the familial disorder seen is associated with bilateral multiple fibroadenomas.
Amiodarone and chronic lung fibrosis
Authors: Finnegan M J , Faragher E B
Published: December 2008

A covariate analysis was performed on the major lung function indices that are affected by pulmonary fibrosis in 29 patients who had recently started amiodarone therapy and compared with those of a group of 41 patients who had been treated for a mean of 19.6 months. Patients with other factors which affect gas transfer were excluded. A trend towards reduction in transfer factor, transfer coefficient and membrane diffusion was detected but did not reach statistical significance. A lower than expected incidence of acute pulmonary fibrosis was observed. In the treated group, there was no deterioration of transfer factor, transfer coefficient or membrane diffusion with either increasing duration of therapy or total dose taken.
Blood lipid variability in relation to relative weight and biochemical markers of tobacco and alcohol consumption
Authors: Janzon L , Franzén J , Lindell S-E , Trell E
Published: December 2008

Carboxyhaemoglobin (COHb%) and gamma-glutamyl-transferase (GGT) are today frequently used as objective indicators of tobacco and alcohol consumption. The relationships between COHb%, GGT and relative body weight, cholesterol, triglyceride and apolipoprotein AI (Apo-AI) were studied in middle-aged men attending a preventive medical programme in Malmö, Sweden. Although statistically significant the influence of COHb% on cholesterol and triglyceride was found to be clinically insignificant. GGT and body weight had, independent of each other, a significant influence on cholesterol and triglyceride. GGT was found to have a positive correlation to Apo-AI whereas body weight was found to have a negative correlation to Apo-AI. Four per cent of the cholesterol variability, 16% of the triglyceride variability and about 10% of the variability in Apo-AI could, in this study, be accounted for by COHb%, GGT and relative body weight.
The value of screening for autoantibodies in patients with non-specific symptoms
Authors: Patel C , Lloyd R S , Holdstock G
Published: December 2008

An autoantibody screen is often requested in patients with non-specific symptoms such as pyrexia of unknown origin. However, in a survey of 100 consecutive requests for this investigation in such patients only one patient was encountered in whom the investigation led to a positive diagnosis at an estimated cost of £2500. These requests accounted for 5% of the total workload. These observations reaffirm that this should remain a second line investigation and should be deferred until more likely diagnoses have been excluded.
Pituitary function with a solitary intrasellar plasmacytoma
Authors: Evans P J , Jones M K , Hall R , Scanlon M F
Published: December 2008

A solitary intrasellar plasmacytoma with marked pituitary fossa destruction and yet near normal pituitary gland function is described. We suggest that a minimal disturbance of endocrine function together with a radiologically abnormal pituitary fossa indicates that the primary lesion may lie outside the pituitary fossa.
Status epilepticus and near hanging
Authors: Dinsmore W , Crane J , Callender M E
Published: December 2008

We report a case of status epilepticus lasting 5 h provoked by attempted self-hanging in a patient with no previous history of epilepsy. We are unable to find any published reports of status epilepticus being provoked in this manner.
Fatal varicella in a healthy young adult
Authors: Coppack S W , Doshi R , Ghose A R
Published: December 2008

A healthy adult presented with severe neurological disturbance 4 d after developing chicken-pox. Although pneumonic and renal problems were also present the neurological state dominated the clinical picture. After the patient's sudden death an autopsy revealed that renal and cerebral problems were secondary to myocardial involvement. This was of an unusual type for varicella with features of dilated cardiomyopathy resembling that previously related to Coxsackie infections. We conclude that cardiac problems in this patient produced anoxic brain damage and subsequently death.
Intramural gas in the small bowel followed by chronic obstruction
Authors: Waldron R P , Dawkins D , Donovan I A
Published: December 2008

A 63 year old male presented with recurring abdominal pain dating from an acute episode 3 months previously. Abdominal X-rays in the acute phase demonstrated small intestinal intramural gas. A jejunal stricture with panmural necrosis was resected.
An unusual complication of stenosis of a colostomy
Authors: Haiart D C
Published: December 2008

A patient is reported in whom stenosis of the colostomy was responsible for perforation of the colostomy by a bone. Necrotizing gangrene of the abdominal wall developed. The management of the resulting full thickness defect of the abdominal wall is described.
A clinical trial using co-trimoxazole in an attempt to reduce wound infection rates in dog bite wounds
Authors: Jones D A , Stanbridge T N
Published: December 2008

One hundred and thirteen patients were entered into a randomized, prospective double-blind, placebo controlled trial to assess the use of co-trimoxazole in reducing wound infections after dog bites. Although there was a reduction in the wound infection rate from 13.8% in the placebo group to 5.5% in the treatment group this did not reach statistical significance (P = 0.135). If hand wounds are considered separately, no infections occurred in the treatment group and a benefit seems likely.
Periductal mastitis and mammary duct ectasia in a male
Authors: Ashworth M T , Corcoran G D , Haqqani M T
Published: December 2008

A case of periductal mastitis and mammary duct ectasia is presented in a 50 year old male, with presenting symptoms similar to those of females, namely subareolar breast lump and mastalgia. As far as can be ascertained only 4 cases of mammary duct ectasia and periductal mastitis in males have been reported previously. Since this entity is not well known in males it is possible that it may be underdiagnosed or misdiagnosed clinically and histologically.
Sudden death due to isolated adrenal tuberculosis
Authors: Ward S , Evans C C
Published: December 2008

A 65 year old man admitted to hospital for investigation of pleural thickening was found to have carcinoma of the prostate with metastases. Before investigations were completed the patient collapsed unexpectedly with hypotension. A post mortem examination revealed tuberculosis of both adrenal glands without evidence of tuberculosis in any other organ.
Segmental infarction of the omentum: diagnosis by ultrasound
Authors: Naraynsingh V , Barrow R , Raju G C , Manmohansingh L U
Published: December 2008

Pre-operative diagnosis of segmental infarction of the omentum is difficult because of its rarity and non-specific clinical features. We present a case of omental infarction and suggest that ultrasound scan may be helpful in the diagnosis of this entity.
Normal thyrotrophin response to intravenous thyrotrophin releasing hormone administration: the best index of optimal L-thyroxine therapy in primary hypothyroidism
Authors: Kabadi U M
Published: December 2008

Normalization of basal thyrotrophin (TSH) level is used as the endpoint in L-thyroxine (L-T4) therapy of primary hypothyroidism. However, several reports have questioned the reliability of this index because of seasonal variation of TSH. Therefore, we studied 85 consecutive patients with primary hypothyroidism over a period of 3.5 y. In these patients, TSH response (delta TSH) to intravenous thyrotrophin releasing hormone (TRH) administration was examined when basal TSH was normalized with L-T4 therapy. Eight patients showed a blunted response (delta TSH less than 5 microU), whereas 27 patients demonstrated an exaggerated response (delta TSH greater than 25 microU). Thus, 42% of patients were apparently on inappropriate L-T4 dosage. These abnormal TSH responses normalized on adjusting the L-T4 dosage alone; prolonged therapy with the same dose failed to normalize TSH responses. Minor seasonal variations of basal TSH were observed in 30% of patients. However, TSH response to TRH remained normal. Hence, no adjustment of L-thyroxine dose was required. This study, therefore, demonstrates that normalization of TSH response to TRH administration rather than basal TSH may be the best index of adequate L-thyroxine therapy in primary hypothyroidism.
Disseminated cryptococcosis in a patient receiving chronic haemodialysis
Authors: Banks R , Williams A , Glover S , Burton P , Warnock D , Mackenzie C
Published: December 2008

Systemic infection with Cryptococcosis neoformans is described in a young man receiving maintenance haemodialysis. The organism was identified in thin sections of a cervical lymph node using resin embedding and silver staining. There were no predisposing factors other than uraemia. His clinical infection responded to the combination of oral 5-flucytosine and a total of 2.5 g of intravenous amphotericin B. He remains free of relapse after 30 months.
Microcrystalline hydroxyapatite compound in prevention of bone loss in corticosteroid-treated patients with chronic active hepatitis
Authors: Stellon A , Davies A , Webb A , Williams R
Published: December 2008

To determine whether microcrystalline hydroxyapatite compound (MCHC) could reduce bone loss or its consequences in patients with chronic active hepatitis (CAH) on corticosteroid therapy, a controlled trial was conducted in 36 such patients over a period of 2 years. Both skeletal symptoms (back pain) and fractures were uncommon during the trial period but both showed non-significant differences in favour of the MCHC group and biochemical investigations were suggestive of a reduction in parathyroid over-activity. Continued reduction in bone mineral content of the radius (photon absorptiometry) was halted in those receiving MCHC and iliac crest bone biopsy showed a non-significant increase in trabecular bone volume. The fall in iliac crest cortical plate thickness was significantly less (P < 0.025) in the MCHC group and the results overall were consistent with a beneficial effect from MCHC in corticosteroid-induced osteoporosis.
Asymmetrical lipomatosis: report of two cases
Authors: Enzi G , Digito M , Baldo Enzi G , Perin B , Fiore D
Published: December 2008

We report on two patients with an asymmetrical expansion of fat tissue. At computed tomography, lipomatous tissue proved to be superficially located in one patient and both subcutaneously and deeply located in the second. Signs and symptoms of a peripheral neuropathy were observed in both patients, who were otherwise asymptomatic. The lipolytic activity in post-heparin plasma was normal in both patients. The fat cell size of lipomatous tissue, obtained in one patient by percutaneous needle biopsy, was higher than that of contralateral, uninvolved adipose tissue. The adipose tissue lipoprotein lipase activity in lipomatous tissue was higher than that in normal tissue. High density lipoprotein (HDL), HDL2 and HDL3 cholesterol values were elevated in both patients but not exceeding 1 standard deviation the values of age and sex matched controls. Isoprenaline-stimulated lipid mobilization was similar in lipomatous and in control tissue.
‘Numismatist's pneumonitis.’ A case of acute nitrogen dioxide poisoning
Authors: Sriskandan K , Pettingale K W
Published: December 2008

A case of acute nitrogen dioxide toxicity is described, together with its management and a review of the possible complications.
Hypertrophic osteoarthropathy, spider naevi and oestrogen hyperexcretion associated with adenocarcinoma
Authors: Brear S G , Edwards J D , Rademaker M , Doyle L
Published: December 2008

We describe two patients with hypertrophic osteoarthropathy, spider naevi and elevated 24 h urinary oestrogen excretion associated with an adenocarcinoma. In one of the patients, the spider naevi and the clinical signs of hypertrophic osteoarthropathy disappeared and the 24 h urinary oestrogen returned to normal following removal of the tumour.
Transitional cell carcinoma of the upper renal tract in rubber workers
Authors: Chapple C R , Newman J , O'Brien J M , Considine J
Published: December 2008

We report two patients where transitional cell carcinoma of the upper urinary tract developed after occupational exposure to known carcinogens, in the rubber industry. Although carcinoma of the bladder is well recognized in this context, to our knowledge, this association has not been reported previously.
Carcinoid tumour arising in a Meckel's diverticulum
Authors: Payne-James J J , Law N W , Watkins R M
Published: December 2008

A patient with a carcinoid tumour arising in a Meckel's diverticulum and presenting with acute small intestinal obstruction is described. Review of previously reported cases indicates that the initial clinical presentation of carcinoid tumours occurring in a Meckel's diverticulum is usually similar to that of appendiceal carcinoids. While most carcinoids in Meckel's diverticula present as incidental findings at post-mortem examination or laparotomy, their metastatic potential and subsequent behaviour resembles that of other small intestinal carcinoid tumours.
Plasma arginine vasopressin in hyponatraemic patients receiving diuretics
Authors: Ghose R R
Published: December 2008

Random estimations of plasma arginine vasopressin concentration were undertaken in 6 non-oedematous patients receiving diuretic therapy for hypertension, who were admitted to hospital with severe hyponatraemia. Hyponatraemia resolved within 2 weeks of discontinuing the diuretic. Measurable amounts of plasma arginine vasopressin were detected in all 6 patients.

Sequential biochemical measurements in one patient, performed when plasma sodium concentration and osmolality were returning to the normal range, disclosed that urine osmolality remained higher than plasma osmolality during the first 5 days, when urine volume and sodium excretion were low. Thus the rise in plasma sodium was not initially related to water diuresis. The ability to excrete a water load was severely limited on the fifth day, but improved progressively by the tenth and seventeenth days.

Diuretic-induced hyponatraemia is associated with incomplete suppression of anti-diuretic hormone secretion arising from non-osmotic stimulation, in conjunction with transient impairment of renal diluting ability which could be due to net sodium deficit.
Peripheral vascular disease—the geriatrician's tale
Authors: Coni N K
Published: December 2008

One hundred and twenty four elderly patients with peripheral vascular disease were seen by a geriatrician over a period of just under 4 years. Half of them presented with critical ischaemia and had not been previously known to have peripheral vascular disease. Two-thirds were shown to have bilateral disease; 14.5% of the series developed manifestations of the condition during the course of acute systemic illnesses and in 5 cases this was almost certainly, and in several more probably, due to haemodynamic crises. A third were dead within 3 months and so far a further 18.5% are known to have died within 2 y of first encounter. Of those who survived 3 months, at least 37% required treatment for persistent rest pain or had skin ulceration or necrosis, or had developed gangrene or come to amputation. Only 5 patients, after investigation, underwent successful limb salvage procedures. Peripheral vascular disease in old people is common, is likely to continue to be so, carries a dismal prognosis, and appears on the evidence presented here to be under-suspected until an advanced stage in the disease. Those dealing with the aged must be constantly on the alert for it since it calls for scrupulous care of the feet and for especial vigilance during acute systemic illness.
Granulocytic sarcoma preceding leukaemic transformation in myelofibrosis
Authors: Jacobs P , Sellars S
Published: December 2008

A granulocytic sarcoma expanded the malar region in a patient with proven myelofibrosis over a 22 month period before undergoing rapid increase in size concomitantly with transformation to acute granulocytic leukaemia in the marrow and the widespread appearance of subcutaneous tumour deposits. Rapid response was obtained with local radiotherapy, and the systemic disease manifestations were controlled on combination courses of oral 4′-demethoxydaunorubicin and the epipodophyllotoxin VP16-213. This appears to be the first example of a granulocytic sarcoma occurring in a patient with myelofibrosis.
Villous adenoma of the ampulla of Vater
Authors: Malik A K , Baruah M K , Pravin N , Kataria R N
Published: December 2008

A case of villous adenoma of the ampulla of Vater in a 40 year old male is described. The clinical significance of this rare tumour is discussed and the relevant literature reviewed.
Haemodynamic evaluation of diastolic abnormalities in hypertrophic cardiomyopathy
Authors: Grossman William , Paulus Walter , Lorell Beverly H
Published: December 2008

Haemodynamic studies suggest that an important abnormality in diastolic relaxation is characteristic of advanced hypertrophic cardiomyopathy. Current evidence supports the concept that cytosolic Ca++ overload is the pathophysiological basis for this impaired relaxation, and may in turn represent impaired membrane Ca++ pumping activity.
Myocardial gallium-67 imaging in dilated cardiomyopathy
Authors: O'Connell John B , Henkin Robert E
Published: December 2008

The use of gallium-67, an isotope that is avid for areas of inflammation in patients with dilated cardiomyopathy, is described and compared with endomyocardial biopsy in 68 consecutive patients with dilated cardiomyopathy. Myocarditis was diagnosed in 8% on biopsy and the likelihood of a positive biopsy when the gallium scan was positive for inflammation, rose to 36%. It is concluded that gallium scanning is a useful adjunct to biopsy in detecting myocarditis in patients with dilated cardiomyopathy and in following patients with evidence of myocarditis on biopsy.

Disadvantages of gallium-67 imaging include the radiation dose accumulated with multiple scans and 72h delay from initial injection of the isotope to imaging. It is suggested that definitive conclusions regarding the technique should await the results of a large multicentre trial evaluating gallium in comparison with endomyocardial biopsy in the diagnosis of myocarditis.
Objective relief of vasospasm by glyceryl trinitrate in secondary Raynaud's phenomenon
Authors: Coppock J S , Hardman J M , Bacon P A , Woods K L , Kendall M J
Published: December 2008

An objective response to topical glyceryl trinitrate was shown by digital plethysmography in a study of 17 patients with Raynaud's phenomenon. Improvement was significant (P < 0.005) in those in whom the disease was secondary to an underlying connective tissue disorder. The response suggests that the effect of this drug is mediated locally.
Pseudo-splenomegaly as a result of subphrenic abscess
Authors: Snape J , Baker A R , Rees Y
Published: December 2008

A case of left-sided subphrenic abscess, secondary to perforation of a carcinoma of stomach, is described. The patient presented with a palpable spleen which was shown to be normal in size but displaced by the subphrenic collection. The importance of correct interpretation of this physical sign is discussed.
Polyarteritis nodosa and monocytic leukaemia
Authors: Leung A C T , McLay A , Boulton-Jones J M
Published: December 2008

A 67 year old man presented with a polyarteritis nodosa-like syndrome with renal, pulmonary joint and neurological involvement during the ‘preleukaemic’ stage of monocytic leukaemia. The association between these two conditions is discussed.
Gastrointestinal bleeding due to large bowel infiltration by chronic lymphocytic leukaemia
Authors: Tucker J , Cachia P G
Published: December 2008

A 66 year old woman with a 9 year history of chronic lymphocytic leukaemia developed intermittent rectal bleeding for 9 months; sigmoidoscopic biopsy proved that this was due to large bowel infiltration by leukaemia. This is a very rare occurrence.
Mefenamic acid-induced bullous pemphigoid
Authors: Shepherd A N , Ferguson J , Bewick M , Bouchier I A D
Published: December 2008

A 52 year old man developed bullous pemphigoid, Coombs' positive haemolytic anaemia and diarrhoea related to the use of mefenamic acid. Clinical manifestation of the bullous pemphigoid, haemolytic anaemia and diarrhoea resolved following discontinuation of the mefenamic acid. Mefenamic acid should be added to the list of agents that are known to induce bullous pemphigoid.
Vitamin E—its role in neurological function
Authors: Muller D P R
Published: December 2008

Studies in patients with abetalipoproteinaemia, other chronic and severe fat malabsorptive states and a selective defect in vitamin E absorption, together with neuropathological studies in the vitamin E deficient human, monkey and rat indicate that vitamin E is important for normal neurological function. Appropriate vitamin E supplementation is, therefore, advisable for all patients with chronic fat malabsorption who have low serum vitamin E concentrations. Serum vitamin E concentrations should also be measured in patients with spinocerebellar disorders, whatever the aetiology.
Effect of a long acting beta-adrenoceptor blocker on diurnal variation of cardiac dysrhythmias
Authors: Mir M A
Published: December 2008

To investigate circadian variation of cardiac arrhythmias ambulatory electrocardiogram monitoring was carried out before and after one week's treatment with a long acting beta-adrenoceptor blocker, nadolol, in 26 patients who presented with symptoms attributable to arrhythmias. Analysis of the 24 hour profile of premature ventricular contractions showed a significantly (P < 0.05) higher frequency during midday to midnight than between midnight and midday. The frequency of supraventricular tachycardia was significantly (P < 0.05) higher during the periods from 12.00 hours to 16.00 hours (11.0 ± 12) and 16.00 hours to 20.00 hours (11.3 ± 11) than during the periods of 00.00 hours to 04.00 hours (3.6 ± 3) and 04.00 hours to 08.00 hours (6.0 ± 8). The period of the highest incidence of all arrhythmias was between 16.00 hours to 24.00 hours, and that of lowest during the period between 04.00 hours to 12.00 hours (P < 0.01). After one week's treatment with nadolol the frequency of all arrhythmias was strikingly reduced but their pattern of occurrence remained unchanged. These studies suggest that patients who present with symptoms attributable to arrhythmias tend to have these more frequently during the physical and mental activities of the day and evening presumably due to the accompanying sympathetic overactivity.
Bilateral pulmonary arteriovenous fistulae treated with balloon embolization
Authors: Kumar S , Ruttley M J , Fisher D J
Published: December 2008

A patient with bilateral pulmonary arteriovenous fistulae is described who was treated successfully by embolization of the two fistulae with detachable balloons introduced percutaneously through the femoral vein.
Minimal change nephropathy associated with anaplastic carcinoma of bronchus
Authors: Singer C R J , Boulton-Jones J M
Published: December 2008

Nephrotic syndrome associated with extra-renal malignancy shows a characteristic pattern: carcinoma is most frequently associated with membranous glomerulonephritis and Hodgkin's disease with minimal change nephropathy. We report a patient with minimal change nephropathy in association with anaplastic carcinoma of the bronchus. Strong temporal evidence of a causal relationship is presented. The dissociation in the response of the two conditions to treatment of the tumour after relapse may be evidence of an indirect pathogenesis.
Interaction between carbamazepine and dextropropoxyphene
Authors: Yu Y L , Huang C Y , Chin D , Woo E , Chang C M
Published: December 2008

Serious side effects may result from the concurrent administration of the usual dosage of carbamazepine and dextropropoxyphene. Three cases are reported and the mechanisms and implications discussed.
The effect of oral digoxin on sodium excretion, renin-angiotensin-aldosterone system and blood pressure in normotensive subjects
Authors: Cappuccio F P , Markandu N D , Sagnella G A , MacGregor G A
Published: December 2008

The effect of digoxin (0.25 mg t.d.s.) given orally for 5 days, on sodium excretion, plasma renin activity, plasma aldosterone and blood pressure has been studied in 6 normotensive subjects, on a constant sodium intake. Average serum digoxin level measured in 5 subjects on the 5th day of treatment was in the upper range of the therapeutic level (1.92 ± 0.3 nmol/l). Red cell sodium content increased from 9.75 ± 1.2 mmol/l of cells in the control period to 15.3 ± 1.7 mmol/l of cells on the 5th day of digoxin treatment when measured in 4 of the 6 subjects. In spite of this evidence of inhibition of the red cell sodium pump, there was no detectable change in sodium excretion, blood pressure, plasma renin activity and aldosterone.
Femoral vein occlusion following Mc-Vay repair
Authors: Klausner J M , Noveck H , Skornick Y , Lelcuk S , Rozin R R
Published: December 2008

Three cases of femoral vein occlusion following a Mc-Vay repair for femoral and inguinal hernias are presented. Phlebography demonstrated constriction of the femoral vein at the site of the repair. This complication is due to compression of the femoral vein by too tight a repair.
Megaloblastic anaemia due to sulphasalazine responding to drug withdrawal alone
Authors: Grieco A , Caputo S , Bertoli A , Caradonna P , Greco A V
Published: December 2008

A 60 year old man with ulcerative colitis since 1975 and treated with sulphasalazine, presented with severe megaloblastic anaemia caused by folate deficiency. The drug was stopped, and the anaemia recovered promptly. There was no relapse one year later.
Naftidrofuryl-induced acute hepatic necrosis
Authors: de Caestecker J S , Heading R C
Published: December 2008

Acute hepatic necrosis is described in a 60 year old woman treated with naftidrofuryl for 5 months.
Hypoglycaemia and cerebral malaria
Authors: Kiire C F
Published: December 2008

A patient with severe hypoglycaemia complicating cerebral malaria is reported. No other recognized cause of hypoglycaemia was detected during life or at autopsy. This case adds to the existing evidence that, through several possible mechanisms, cerebral malaria can give rise to life-threatening hypoglycaemia.
Clostridial myonecrosis in association with etoposide therapy presenting as severe thigh pain
Authors: Smith D , Harris M , Thatcher N
Published: December 2008

The case is described of a 68 year old man who was immunosuppressed as a result of receiving chemotherapy for small cell lung cancer and who presented with severe right thigh pain. This proved to be due to clostridial myonecrosis with none of the classical clinical features of clostridial infection. This is believed to be the first reported case of spontaneous clostridial infection associated with etoposide administration.
Yersinia arthritis with erythema nodosum
Authors: Luqmani R A , Dawes P T
Published: December 2008

A previously healthy female presented with erythema nodosum and arthritis with serological evidence of infection with Yersinia enterocolitica. Erythema nodosum following this infection has not previously been reported in Britain.
Indium-111 leucocyte scintigraphy in the investigation and management of inflammatory bowel disease
Authors: Fotherby K J , Wraight E P , Garforth H , Hunter J O
Published: December 2008

The results of indium-111 tropolonate leucocyte scintigraphy in 105 patients with known inflammatory bowel disease are reviewed. Scintigraphy is as sensitive as radiology in detecting and assessing the extent of active colonic disease, and probably more sensitive in assessing small bowel disease. In a further 40 patients scintigraphy was successfully used as a screening test to identify, or exclude, bowel inflammation in patients with gastrointestinal symptoms. Scintigraphy has advantages over barium studies, being safe, non-invasive, more sensitive than small bowel radiology and giving additional information such as the bowel identification of intra-abdominal abscesses. The time required to label the leucocytes (about 2 hours) and the higher unit cost, unless many scintigrams are performed, are disadvantages.
Thymectomy in myasthenia gravis during pregnancy
Authors: Ip M S M , So S Y , Lam W K , Tang L C H , Mok C K
Published: December 2008

A 24 year old woman with myasthenia gravis suffered an antepartum exacerbation which failed to respond to increasing dosages of pyridostigmine. Thymectomy performed in the second trimester was followed by clinical improvement and full term vaginal delivery with no puerperal deterioration.
Recurrent hypercalcaemia in a young man with mono-ostotic Paget's disease
Authors: Bannister P , Roberts M , Sheridan P
Published: December 2008

A 32 year old man presented on two separate occasions with severe hypercalcaemia. Both episodes followed the fracture of a single pagetic bone but were not associated with immobilization. To our knowledge this patient, the youngest described with hypercalcaemia secondary to Paget's disease of bone is also the only reported case of recurrent hypercalcaemia in this condition.
Pneumonectomy in pulmonary mucormycosis complicating Behçet's disease
Authors: Santo M , Levy A , Levy M J , Weinberger A , Mor R , Avidor I , Rousso I , Pinkhas J
Published: December 2008

A 37 year old man with Behçet's disease who was maintained on prolonged corticosteroid therapy, developed diabetic ketoacidosis and pneumonia. Secondary infection with mucor intervened with abscess formation cured by pneumonectomy. The association of Behçet's disease and mucormycosis has not been previously reported, although diabetes mellitus was almost certainly the predisposing cause. Surgical treatment offers the best chance of survival in similar cases.
Hodgkin's disease in an adult with acute lymphoblastic leukaemia
Authors: Zuiable A , Borthwick-Clarke C , Maitland J , Clink H , Powles R
Published: December 2008

A 53 year old woman with common acute lymphoblastic leukaemia (ALL) developed Hodgkin's disease 20 months after the initial diagnosis of ALL. This is by far the oldest case of Hodgkin's disease complicating ALL. The unusual presentation and the aetiology of Hodgkin's disease in ALL are discussed.
Human serum parvovirus associated vasculitis
Authors: Li Loong T C , Coyle P V , Anderson M J , Allen G E , Connolly J H
Published: December 2008

A 48 year old man had a severe symmetrical arthritis of knee and ankle joints accompanied by an extensive purpuric rash of both legs and several areas of skin necrosis. No other system was clinically involved. Human serum parvovirus-specific IgM was present in a blood sample taken 2 weeks after the onset of the clinical illness indicating recent infection with this virus. The patient was treated with complete bed rest, and the application of saline soaks to both legs. He had a recurrence of the rash 5 weeks after onset, but otherwise made a complete recovery. Purpura with skin necrosis has not previously been reported in association with this virus.
Uric acid bladder stone associated with a foreign body
Authors: Williams D J
Published: December 2008

A uric acid bladder stone is described. This stone was unusual in that it had formed on a foreign body, namely surgical suture material. This phenomenon does not appear to have been described previously.
Radionuclide assessment of left ventricular function in hypertrophic cardiomyopathy
Authors: Sugrue D D , McKenna W J
Published: December 2008

To determine the relationship of left ventricular function and ventricular tachycardia, 48 hour ECG monitoring and technetium-99m gated equilibrium radionuclide angiography were performed in 84 consecutive patients with hypertrophic cardiomyopathy and sinus rhythm. Measurements of ejection fraction (EF), peak ejection rate (PER, edv/s), peak filling rate (PFR, edv/s) and time to peak filling rate (PFR, ms) were derived from radionuclide activity time curves generated from data acquired in list-mode. Left ventricular function was compared in patients with and without ventricular tachycardia. Left ventricular ejection fraction was significantly lower in 16 patients with ventricular tachycardia compared to 68 patients without (67 ± 17 vs 78 ± 10, P < 0.05) and time to peak filling rate was significantly prolonged (152 ± 32 vs 120 ± 36, P < 0.05). Thus patients with hypertrophic cardiomyopathy at greatest risk of sudden death had significant impairment of systolic and diastolic left ventricular function.
The role of echocardiography in the assessment of hypertrophic cardiomyopathy
Authors: Rakowski H , Fulop J , Wigle E D
Published: December 2008

Echocardiography has greatly simplified the diagnosis of hypertrophic cardiomyopathy and routine haemodynamic studies are usually only required in patients being considered for myectomy or the assessment of coexistent coronary disease. A complete echo Doppler study should be performed in all patients with hypertrophic cardiomyopathy to define the degree of obstruction, the degree of asymmetric hypertrophy and abnormalities of diastolic function. In this manner the patient can be classified according to haemodynamic subgroup, thus influencing the choice of treatment and helping to determine prognosis. These studies also provide a simple quantitative method of assessing the beneficial effects of medical or surgical therapy.
Arrhythmias in dilated cardiomyopathy
Authors: Neri R , Mestroni L , Salvi A , Camerini F
Published: December 2008

Sixty-five patients with dilated cardiomyopathy underwent 24 hour electrocardiographic monitoring: 62 (95.4%) showed ventricular arrhythmias and 52 (80%) complex ventricular arrhythmias (multiform ventricular extrasystoles, paired ventricular extrasystoles and ventricular tachycardia).

Complex ventricular arrhythmias correlated significantly with some haemodynamic indices of ventricular dysfunction: patients with multiform and paired ventricular extrasystoles and with ventricular tachycardia had lower values of ejection fraction (31.9 ± 11.8%, P = 0.002) and of cardiac index (2.9 ± 0.7 litres/min/m2, P = 0.029) than the others (41.1 ± 11.1% and 3.5 ± 0.9 litres/min/m2 respectively).

Patients were followed for a period of 30 ± 18 months (20 days to 64 months). During follow-up 19 died and mortality was higher among patients with multiform and paired ventricular extrasystoles and/or ventricular tachycardia.

Complex ventricular arrhythmias are frequent in dilated cardiomyopathy: ventricular tachycardia and multiform and paired ventricular extrasystoles seem to be related to a more depressed ventricular function and to a poor prognosis. The importance of antiarrhythmic treatment in these patients has still to be evaluated.
Tuberculous meningitis due to Mycobacterium bovis: a report of two cases
Authors: Wilkins E G L , Griffiths R J , Roberts C , Green H T
Published: December 2008

Two Caucasian patients with bovine tuberculous meningitis are described. Classical Mycobacterium bovis was isolated from the cerebrospinal fluid on both occasions. Despite the elimination of cattle tuberculosis in this country, reactivated primary disease due to the bovine tubercle bacillus may still occur.
Primary liposarcoma of the heart
Authors: Cyjon A , Rakowsky E , Mor C , Barzilay J
Published: December 2008

A rare form of primary heart tumour, a liposarcoma, is reported. A discussion of diagnosis and modalities of treatment of primary heart sarcomas is presented.
Femoral hernia causing pneumoperitoneum
Authors: King H A , Boulter P S
Published: December 2008

Richter's hernia, in which only a portion of the circumference of the intestine lies within the sac, is a common complication of femoral hernia. This case report is of 39 year old female who presented with a pneumoperitoneum and was found at laparotomy to have a right femoral Richter's hernia containing a knuckle of perforated small bowel. This is a previously unreported presentation of femoral hernia.
Mechanisms by which stress can lead to coronary heart disease
Authors: Henry J P
Published: December 2008

Much stress is of psychological origin and due to emotional arousal. The mechanisms by which anger, helplessness, or a sense of control and serenity exert their various neuroendocrine effects are discussed. Primacy is given to three systems; to the catecholamines, to testosterone and to cortisol. Evidence that they interact to accelerate the arteriosclerotic process is cited. The protective aspects of intimacy are discussed together with evidence that certain personality types promote it in the marital situation while others do not. It is suggested that the post-traumatic stress syndrome may relate to the coronary-prone personality for it involves an alexithymic disturbance of the emotional competence required for successful intimacy.
Meningioma following cranial irradiation
Authors: Hill S A
Published: December 2008

The case of a middle aged man who developed a meningioma directly underneath the site of a naevus treated with radiotherapy as a child, is presented. Epidemiological evidence and reports of similar cases suggesting meningiomas may be a sequel to irradiation, are reviewed.
Mesenchymal hamartoma of the liver—report of an unusual case
Authors: Salisbury J R , Darby A J , Portmann B C
Published: December 2008

An 8 year old girl presented with gross hepatomegaly, anaemia and pyrexia unresponsive to antibiotics. At laparotomy a cystic mass 19 cm in diameter was found arising from the liver. The cyst contained 2.4 litres of changed blood and an abscess cavity filled with thick pus was present in the cyst wall. Histological examination showed the appearances of a mesenchymal hamartoma of the liver, a rare diagnosis at this age. This case is unusual as mesenchymal hamartoma has not been previously reported presenting with pyrexia and anaemia as well as hepatomegaly.
Colitis caused by non-steroidal anti-inflammatory drugs
Authors: Ravi S , Keat A C , Keat E C B
Published: December 2008

Four cases of acute proctocolitis associated with non-steroidal anti-inflammatory drug therapy are presented. The drugs implicated were flufenamic acid, mefenamic acid, naproxen and ibuprofen. After resolution of symptoms and signs of proctocolitis three of the four patients were subsequently rechallenged with the implicated drug: in each there was a rapid relapse.
Familial cerebral palsy associated with normal intelligence
Authors: Wild N J , Rosenbloom L
Published: December 2008

We describe two families affected by a recessively transmitted familial cerebral palsy with onset in infancy. Two sisters in the first family have a severe spastic diplegia. The older sister also has mild mental retardation and hypothyroidism whilst the younger sister is of normal intelligence. Two brothers in the second family have a spastic quadriparesis, fifth finger camptodactyly and normal intelligence.
Comparison of the effects of atenolol, sotalol and labetalol on muscle blood flow in man
Authors: Raman G V , Mwongera F M , Warren D J
Published: December 2008

A double-blind study of the effect of three beta-adrenoceptor blocking drugs (beta-blockers) on exercise muscle blood flow (MBF) in 14 normotensive volunteers was carried out. MBF was measured by the xenon-133 clearance technique. MBF was not altered by placebo, sotalol or labetalol. Atenolol significantly reduced MBF compared with placebo, sotalol and labetalol.

We conclude that sotalol and labetalol may be more useful than conventional beta-blockers for treatment of hypertension or angina in association with peripheral vascular disease.
Primary hypothyroidism with paradoxically elevated plasma thyroxine due to thyroxine-binding antibody
Authors: Hague R V , Higgins S P , May W J
Published: December 2008

Investigation of an elderly patient with clinical hypothyroidism revealed a low serum triiodothyronine (T3) but markedly raised levels of total thyroxine (TT4) and free thyroxine (fT4) when measured by radio-immunoassay (RIA). Primary hypothyroidism was suggested by an elevated basal thyroid stimulating hormone (TSH) and confirmed by a low fT4 when measured by a commercial microencapsulated antibody method. The paradoxically elevated levels of fT4 and TT4 were due to the presence of an antibody which specifically bound T4 and grossly interfered with the RIA thus complicating the diagnosis and later the assessment of replacement therapy. The sensitive immunoradiometric TSH assay proved of value in resolving these problems.
Unilateral thyroid swelling due to actinomycosis
Authors: Arfeen S , Boast M T , Large D M
Published: December 2008

A case of unilateral thyroid swelling due to actinomycosis in a 27 year old farm worker is described. Diagnosis was made by fine needle biopsy under ultrasound control.
Papillary carcinoma in a giant lateral thyroglossal cyst
Authors: Banerjee S N , Ananthakrishnan N , Veliath A J , Ratnakar C
Published: December 2008

The development of carcinoma in a thyroglossal cyst is rare. This report describes the presence of papillary carcinoma in a giant thyroglossal cyst and reviews the literature regarding the clinico-pathological features of the disease and its management.
Hereditary pancreatitis presenting with ascites
Authors: Rao S S C , Riley S A , Foster P N , Losowsky M S , Stone W D
Published: December 2008

We report a case of an adolescent girl who presented with painless massive ascites secondary to chronic pancreatitis and a ductal fistula. The diagnosis was delayed and an unnecessary laparotomy was performed, as initial evaluation of ascites did not include measurement of serum and ascitic amylase. Evidence of pancreatic abnormalities in asymptomatic relatives suggested an underlying hereditary pancreatitis. Hereditary pancreatitis presenting as pancreatic ascites, to our knowledge, has not been described previously.
Nodular fasciitis induced by epidural injection
Authors: Wray C C , Macdonald A W
Published: December 2008

Nodular fasciitis is a well established clinical entity of unknown pathogenesis. A traumatic aetiology is postulated yet specific examples are not documented. We present a case directly attributable to an epidural injection.
Skin necrosis following Haemaccel
Authors: Allen M B
Published: December 2008

Haemaccel is a plasma substitute in frequent clinical use with a low incidence of side effects. I report a patient who developed necrotic blisters following two Haemaccel-insulin infusions, a previously undescribed complication. The rationale behind carrier solutions for insulin therapy is discussed and some of the problems associated with Haemaccel use are considered. I conclude by urging caution in the use of Haemaccel as a carrier solution for insulin therapy.
C1 esterase inhibitor deficiency in X-linked hypogammaglobulinaemia: an anomaly fostering anaphylactoid reactions following intramuscular gammaglobulin administration
Authors: Pollack S , Cunningham-Rundles C , Good R A , Day N K
Published: December 2008

A patient with apparent X-linked agammaglobulinaemia was found to be inordinately susceptible to anaphylactoid reactions to intramuscular injections of gammaglobulin. The patient was found also to have low levels of C1 esterase inhibitor (C1 INH). The possibility that the C1 INH deficiency and in this patient, whether genetic or acquired, fostered the susceptibility to the production of anaphylactoid reactions after gammaglobulin injections urges further studies of the association of C1 INH deficiency and anaphylactoid reactions to gammaglobulin injections. The possibility that C1 INH levels like C1q levels may be low in hypogammaglobulinaemic patients as a consequence of increased catabolism of this regulator of the complement system when IgG levels are low is considered.
Recurrent sub-mucosal dissection of the oesophagus in association with achalasia
Authors: Hooper T L , Gholkar J , Smith S R , Manns J J , Moussalli H
Published: December 2008

Submucosal dissection of the oesophagus is a rare oesophageal disorder. We report a patient who had recurrent episodes of dissection and achalasia. Both recurrence and the association with achalasia are to our knowledge unique.
Post-menopausal breast abscess
Authors: Raju G C , Naraynsingh V , Jankey N
Published: December 2008

Thirty post-menopausal women with breast abscess were treated at Port of Spain General Hospital, Trinidad, between 1976 and 1980. In this age group, breast abscess can be confused with cancer due to a lack of inflammatory features. History and physical examination are often not helpful in differentiating an abscess from carcinoma. Although the usual treatment of an abscess is incision and drainage, in post-menopausal women, excision of the lesion is helpful for accurate histological diagnosis.
Incomplete Reiter's syndrome following chemotherapy of acute myeloid leukaemia
Authors: Dharmasena F , Englert H , Catovsky D , Galton D A G , Drysdale H C
Published: December 2008

Reiter's syndrome and other reactive arthritides have been described following infection with various organisms although they can occur in unusual circumstances without an obvious infectious precipitant. We have recently witnessed two attacks of reactive arthritis and keratoderma blenorrhagica occurring in an HLA B27 adult male following chemotherapy on two separate occasions with the same drugs for acute myeloid leukaemia. No attacks occurred before or following the cessation of these drugs. This supports the view that in Reiter's syndrome a common pathogenic pathway is triggered by an ‘arthritogenic factor’ which in this case appears to have been chemical.
Fatal intraperitoneal haemorrhage of hepatic origin
Authors: Fidas-Kamini A , Busuttil A
Published: December 2008

Eight cases of fatal haemoperitoneum due to liver bleeding are reported. Two followed trauma (liver biopsy and cholecystectomy). The remaining six were spontaneous, 5 being due to malignant liver disease. The sixth case due to polycystic liver disease appears to be unique. The aetiology and importance of spontaneous hepatic bleeding is discussed.
The distinction between worth and affordability: implications of costs and benefits for the allocation of health care resources
Authors: Charny M C , Roberts C J
Published: December 2008

There is an important distinction between worth and affordability which remains largely unrecognized. It is widely supposed that if an economic analysis shows that the benefits of a service exceed its costs, failure to fund it is irrational and inefficient. By means of a simplified model of a health care system, it is shown that although an excess of benefits over costs is a necessary precondition for providing a service, it is by no means sufficient. If society is to make the best use of its resources in health care, worthwhile services—those which make a social ‘profit’—must be compared with other such services. Since the resources available to any health care system will always be limited, it is likely that not all services whose benefits exceed their costs can be afforded, because the budget has already been committed to those worthwhile services which yield higher benefits per unit cost.
Internal carotid artery occlusion in a young female with mitral valve prolapse
Authors: Saadah M A , Shakir R A , Rudwan M A , Khan N
Published: December 2008

A healthy 28 year old housewife presented with sudden right hemiplegia and aphasia. No predisposing factors could be ascertained apart from posterior cusp mitral value prolapse on two dimensional echocardiography. Extensive investigations confirmed the presence of cerebral infarction and persistent occlusion of the left internal carotid artery near its origin.