bluuebunny/crossref_metadata_2025 huggingface dataset:
Glucose intolerance during diuretic therapy in elderly hypertensive patients. A second report from the European Working Party on high blood pressure in the elderly (EWPHE)
Authors: Amery A , Birkenhäger W , Brixko P , Bulpitt C , Clement D , Deruyttere M , De Schaepdryver A , Fagard R , Forette F , Forte J , Hamdy R , Leonettil G , O'Malley K , Murphy M , Petrie J , Tuomilehto J , Webster J , Williams B
Published: December 2008

Five hundred and seven elderly hypertensive patients were followed for 1 year, 371 for 2 years and 270 for 3 years in a double-blind, randomized, controlled trial in which they received either placebo or 25–50 mg hydrochlorothiazide and 50–100 mg of triamterene daily. One third of the active treatment group also received 250 mg to 2 g methyldopa daily. After 1 year the active treatment group had an average increase in fasting blood sugar of 2.5 mg/dl compared with an average fall of 1.4 mg/dl in the placebo group (P = 0.01). The increase in blood sugar 1 hour and 2 hours after 50 g oral glucose tended to be greater in the actively treated group but these increases did not achieve statistical significance. The effects of diuretic treatment were established after one year and did not increase further over the next 2 years. Overall there was an increase in fasting blood sugar of 5 mg/dl in the active treatment group which occurred mainly in the first year.

The hyperglycaemic effect of diuretics appeared to be partly or wholly related to potassium loss since, in both groups, impairment of glucose tolerance was most marked in those in whom serum potassium decreased. The measures of blood sugar were also positively related to systolic pressure before and after treatment.
Hepatic artery aneurysm
Authors: Curran F T , Taylor S A
Published: December 2008

We describe a 58 year old woman who had an aneurysm involving the common hepatic artery, the right and left hepatic arteries and the cystic artery which had ruptured into the liver. It was successfully treated by proximal ligation. The features and management of hepatic artery aneurysm are discussed.
Spontaneous splenic rupture in polyarteritis nodosa
Authors: Ford G A , Bradley J R , Appleton D S , Thiru S , Calne R Y
Published: December 2008

A 28 year old man presented with haematuria and renal failure. Renal arteriography revealed bleeding into the pelvis of a solitary right kidney from a hilar artery. Multiple aneurysms were noted in the splenic artery. The spleen subsequently ruptured spontaneously and was removed at laparotomy together with the right kidney. Histological examination of the spleen and kidney revealed an acute necrotizing vasculitis involving medium-sized and smaller arteries confirming a diagnosis of polyarteritis nodosa. An area of infarction involved a subcapsular area of the spleen. Spontaneous splenic rupture is a rare but important complication of systemic vasculitides.
Prediction of spontaneous coronary reperfusion in myocardial infarctionPresented in part on the 57th Scientific Sessions of The American Heart Association, Miami Beach, November 12–15, 1984
Authors: Verheugt F W A , Visser F C , van der Wall E E , van Eenige M J , Res J C J , Roos J P
Published: December 2008

To investigate the possibility of predicting the occurrence of spontaneous coronary reperfusion in acute myocardial infarction we studied 91 patients in a randomized trial on the clinical efficacy of intracoronary streptokinase compared to conventional treatment. Of the 46 patients treated conventionally 40 had catheterization 6 weeks after the infarction. Spontaneous coronary reperfusion was found in 19 patients (48%). The time to peak CK-MB in these patients was considerably longer than in patients with streptokinase-induced coronary reperfusion and similar to the time in patients without spontaneous coronary reperfusion. Spontaneous coronary reperfusion was associated with a relative improvement of radionuclide ejection fraction from day 1 to day 14 after admission. There was no difference in the occurrence of ventricular arrhythmia or recurrent ischaemic events between the patients with and those without spontaneous coronary reperfusion.

Thus, spontaneous coronary reperfusion is not uncommon in traditionally treated myocardial infarction, but its occurrence cannot be predicted by enzymatic or clinical parameters.
Alcohol and blood pressure: a social comparison in Zimbabwe
Authors: Bursztyn P G
Published: December 2008

The blood pressures of 252 men and 250 women, living in both urban and rural Zimbabwe, were measured on three separate occasions. Food and alcohol intakes were determined using a 3-day weighed diet survey checked by means of a detailed interview. Anthropometric data were also collected. No relationship was found between mean blood pressures and the alcohol intake for any socioeconomic group. Using only the first of the three blood pressure measurements, a correlation between systolic pressure and alcohol intake was found for white males (r = 0.234, P < 0.05), and just missed statistical significance (r = 0.156, P = 0.065) for black middle class males. No relationship was found between blood pressure and alcohol consumption for black working class males, or for females.

Epidemiological evidence suggests that alcohol consumption is associated with increased blood pressure. However, a convincing physiological mechanism is lacking. It is suggested that psychological factors may be partly responsible for this relationship.
Encephalopathy in renovascular hypertension associated with the use of oral contraceptives
Authors: Bradley J R , Reynolds J , Williams P F , Appleton D S
Published: December 2008

Two female patients aged 19 years and 27 years presented with hypertensive encephalopathy and were subsequently found to have renal artery stenosis due to fibromuscular dysplasia. Both patients had had normal blood pressures recorded within the previous 6 months whilst taking the oral contraceptive pill. Their neurological state returned to normal with hypertensive control and in one case the hypertension was cured by dilatation of the renal artery stenosis by balloon angioplasty.
Osseous choristoma presenting as a cold solitary thyroid nodule
Authors: Banerjee S N , Ananthakrishnan N , Veliath A J , Ratnakar C
Published: December 2008

A hitherto undescribed case of an osseous choristoma of the thyroid presenting as a single cold nodule is presented. The possible origin of the lesion is discussed.
Intraluminal mucus cast complicating carcinoma of the colon
Authors: Chapple C R , Shah V M , Newman J
Published: December 2008

A previously unreported complication of a stenosing carcinoma of the colon is described. This was first noticed as a rather unusual X-ray appearance, the significance of which only became clear following surgery.
Propranolol pharmacokinetics during the menstrual cycle
Authors: Abdu-Aguye I , Dunlop D , Patel P , Turner P
Published: December 2008

The pharmacokinetics of propranolol during menstruation and in the mid menstrual cycle have been studied in nine young women taking a single 80 mg tablet on each occasion. There were wide between-individual differences in the serum concentration at any given time (4-5 fold at peak concentrations) but the serum concentration time curves within individuals showed only mild variations. The differences between the average pharmacokinetic parameter estimates for the group did not differ significantly between the two periods of study.
Non-palpable breast lesions: out-patient needle localization and biopsy
Authors: Smith-Behn J , Ghani A
Published: December 2008

One hundred and nine patients undergoing out-patient needle localization and biopsy of non-palpable breast lesions were studied. Six patients with carcinoma were detected, 5 of them qualifying as minimal carcinoma. Thirty five patients with proliferative fibrocystic breast disease in need of careful follow-up were identified. While the number of patients with carcinoma was low, the early stage of their disease justifies continued use of the procedure. Doing the procedure on an out-patient basis has been shown by others to provide a substantial reduction in cost. Our results suggest that the out-patient setting does not affect the morbidity or mortality of the procedure.
Pyogenic infection and rheumatoid arthritis
Authors: Rowe I F , Deans A C , Keat A C S
Published: December 2008

Ten episodes of severe pyogenic infection occurring in nine patients with rheumatoid arthritis are reported. There was a wide range of presenting features including pyoarthrosis in 7 episodes. Three cases presented with meningitis, bacterial endocarditis and probable multiple abscesses respectively. Infection was caused by Staphylococcus aureus in 7 episodes and by Staphylococcus epidermidis, Streptococcus pneumoniae and beta-haemolytic Streptococcus in each of one episode. Three infective episodes were fatal. Pyogenic, especially staphylococcal, infection should be considered in patients with rheumatoid arthritis with unexplained illness with or without sudden deterioration in joint symptoms. It is important to recognize and treat infection rapidly.
Chylothorax after high translumbar aortography
Authors: McMurdo Met
Published: December 2008

Chlothorax is a rare complication of high translumbar aortography and a case is described here.
Hypersensitivity reactions to drugs in acquired immunodeficiency syndrome
Authors: Ackerman Z , Levy M
Published: December 2008

We describe a patient with AIDS in whom recurrent drug eruption and fever following administration of various unrelated agents developed. Previous drug exposure was uneventful. A possible mechanism for this phenomenon is described.
Normal pressure hydrocephalus presenting as Parkinson’s syndrome
Authors: Miodrag A , Das T K , Shepherd R J
Published: December 2008

Although extrapyramidal features in normal pressure hydrocephalus (NPH) are not uncommon, presentations with Parkinson’s syndrome as the predominant feature are rare and may give rise to diagnostic difficulties. Failure of patients with parkinsonism to respond to therapy, should alert one to the possibility of NPH.
Amyloid myopathy and myeloma: response to treatment
Authors: Sheehan-Dare R A , Simmons A V
Published: December 2008

A 57 year old female presented with an amyloid myopathy in association with lambda light chain myeloma. Treatment with melphalan and prednisolone resulted in remission of both myeloma and myopathy.
Metastatic teratoma from a regressed impalpable testicular primary
Authors: Abel P D , Williams G
Published: December 2008

A young man presented with a perineal tumour which despite intensive investigation, remained of unknown origin and required radical excision. It was subsequently shown to be a metastasis from a primary regressed testicular teratoma. It is important to exclude a testicular origin in these patients wherever possible because such tumours are often chemosensitive.
Ileal carcinoma and tuberculous ileitis
Authors: Cooper M J , Williamson R C N , Smith J H F
Published: December 2008

A 76 year old woman presented with abdominal pain and weight loss. At laparotomy she was found to have an adenocarcinoma of the ileum arising in a segment of tuberculous ileitis. The possible significance of this association is discussed.
ERCP in late post-traumatic biliary fistula
Authors: Barclay G R , Crampton J R
Published: December 2008

A case is described in which a huge subcapsular bile collection due to biliary fistula presented late after hepatic trauma and in which ERCP indicated the diagnosis.
The BMRES 1984 Medical Research Expedition to the Himalayas
Authors: Bradwell A R , Coote J H
Published: December 2008

Twenty-one subjects formed a trekking expedition to study the effects of acetazolamide on exercise performance and acclimatization at high altitude. Subjects were randomized to acetazolamide or placebo on a double blind basis. During ascent to and stay for 6 nights at 4846 m studies were carried out on blood gases, 2,3 diphosphoglycerate (2,3 DPG), proteinuria, exercise testing, intestinal absorption, purine metabolism and changes in body composition. The results showed beneficial effects of acetazolamide on exercise performance and preservation of muscle mass.
Effects of acetazolamide on cerebral blood flow and brain tissue oxygenation
Authors: Lassen N A , Friberg L , Kastrup J , Rizzi D , Jensen J J
Published: December 2008

Oral administration of 1 g of acetazolamide to 8 normal subjects studied at sea level and in normoxia caused an acute increase in cerebral blood flow (CBF). During the subsequent prolonged oral treatment with 1 g of acetazolamide daily, CBF returned to normal within 2 days. The alveolar CO2 tension decreased gradually to 70% of the control value, indicating hyperventilation. At sea level hyperventilation will not increase brain oxygenation significantly in normal man, as the arterial oxygen content only increases minimally, while CBF is unchanged. At high altitude the beneficial effects of acetazolamide on the symptoms of acute mountain sickness may well be due to an improved oxygen supply to the brain, as hyperventilation will, at the low ambient PO2, cause a significant increase of the arterial oxygen content, while CBF presumably is unaffected by the drug. During hypoxia at high altitude the overall effect of prolonged acetazolamide treatment may thus be equivalent to a descent by several hundred metres.
Slow-release potassium and perforation of Meckel’s diverticulum
Authors: Layer G T , Scott-Jupp R H , Maitra T K , Darke S G
Published: December 2008

A case of peritonitis following perforation of gastric-type mucosa in a Meckel’s diverticulum is described. At laparotomy a wax core of a combined diuretic-slow-release potassium preparation was found extruding through the perforation and a further pellet was found free in the peritoneal cavity. Intestinal perforation due to potassium-containing drugs is recognized and led to the development of enteric-coated and slow-release delivery systems. The association of perforation of Meckel’s diverticulum with a slow-release potassium perforation has not previously been described.
Epithelioid sarcoma presenting as the reflex sympathetic dystrophy syndrome
Authors: Summers C L , Shahi M
Published: December 2008

A case of reflex sympathetic dystrophy caused by an epithelioid sarcoma is presented. This is the first report of a local peripheral tumour associated with the reflex sympathetic dystrophy syndrome.
Growth hormone responses to hp GRF 1-44 amide, bromocriptine and stress in acromegaly are correlated
Authors: Belchetz P E
Published: December 2008

The results of testing growth hormone (GH) reserve using human pancreatic growth hormone-releasing factor 1-44 amide (hp GRF 1-44 amide) have been compared with the GH responses in a variety of other dynamic tests in seven acromegalic patients. The GH release following hp GRF 1-44 amide correlated with the GH suppression following bromocriptine, but showed an inverse correlation with the GH release following stress tests (insulin-induced hypoglycaemia/glucagon). There was no correlation between the GH responses in these three tests and any of the other tests: TRH, GnRH and glucose. A hypothesis is proposed to explain these findings on the basis of varying degrees of GH secretion from adenomatous and normal pituitary somatotrophs in acromegaly.
Primary malignant neoplasms associated with chronic lymphocytic leukaemia
Authors: Lishner M , Prokocimer M , Ron E , Shaklai M
Published: December 2008

The relationship between chronic lymphocytic leukaemia (CLL) and primary malignant neoplasms was evaluated using data from the Hematology Division in Beilinson Medical Center and the Israel Cancer Registry.

The study population consisted of 81 patients diagnosed between 1962 and 1984. A total of 16 patients were found to have 21 malignant neoplasms in addition to their CLL. Excluding patients with nonmelanoma skin tumours, a 1.7 increased risk (statistically not significant) for developing second malignant neoplasms in CLL patients was detected.

The only tumour which occurred significantly more than expected subsequent to CLL diagnosis was brain cancer. The coexistence of multiple cancers in the same patient was diagnosed in four of the patients.

The results of this study further support the hypothesis that patients with CLL are prone to develop second neoplasms.
Real time ultrasound, arterial pulsation and neonatal cerebral infarction
Authors: Donaldson B
Published: December 2008

This paper describes an infant whose cranial ultrasound scan showed marked unilateral cerebral arterial pulsation and enlargement without other abnormality. Subsequent computerized tomogram showed extensive cortical infarction in an area not readily accessed by ultrasound.

It is concluded that the real time dimension of cranial ultrasound is of diagnostic value in the absence of demonstrable parenchymal or intraventricular abnormality.
Familial dysalbuminaemic hyperthyroxinaemia
Authors: Fleming S J , Applegate G F , Beardwell C G
Published: December 2008

Familial dysalbuminaemic hyperthyroxinaemia (FDH) can be confused with thyrotoxicosis if clinical signs and laboratory tests are misinterpreted. We describe three members of the same family with FDH who were erroneously treated for thyrotoxicosis. Screening of other family members resulted in the discovery of a further six patients at risk of being misdiagnosed as thyrotoxic. Clinical and biochemical findings relevant to the diagnosis of FDH are discussed.
Surgical complications of amyloid disease
Authors: O’Doherty D P , Neoptolemos J P , Bouch D C , Wood K F
Published: December 2008

The case of a man with primary systemic amyloidosis without myelomatosis and long-term survival is described. The patient has had major surgical complications from large amyloid deposits in the colon, dorsal spine and peritoneal cavity. The patient remains well 14 years after diagnosis.
Profound hypotension after the first dose of ketanserin
Authors: Waller P C , Cameron H A , Ramsay L E
Published: December 2008

Two patients developed profound hypotension approximately one hour after taking an initial oral dose of ketanserin 40 mg. The reaction appeared similar to that reported with prazosin, and may have been due to the alpha 1-adrenoceptor antagonist action of ketanserin. Both patients were taking regular beta-blocker therapy, which may exacerbate such a reaction.
A serial study of platelet reactivity throughout the first six months after myocardial infarction: its modification by sulphinpyrazone
Authors: Kubik M M , Richardson S G N
Published: December 2008

Platelet reactivity was studied immediately after and throughout the first 6 months following myocardial infarction. Its modification by sulphinpyrazone was observed.

Out of 65 consecutive patients admitted to the coronary care unit, ten did not meet the protocol criteria. Fifty five received either placebo or sulphinpyrazone in a double-blind trial for 6 months, treatment being started within 6 days of infarction. Forty four patients completed the study (19 on placebo and 25 on sulphinpyrazone). An additional ten patients commenced treatment within one day of infarction and were studied daily for one week. Platelet hyper-reactivity was demonstrable in all patients at presentation and persisted throughout the 6 months in the control group. This effect was reversed by sulphinpyrazone, the modification of reactivity being established by the third day of treatment.
Impaired splenic function in systemic amyloidosis
Authors: Selby C D , Sprott V M A , Toghill P J
Published: December 2008

In four cases of biopsy proven amyloidosis there was evidence of impaired splenic function. All had absent or grossly reduced splenic uptake on colloid isotope scans and three had haematological changes consistent with hyposplenism. Poor splenic function with a normal sized or enlarged spleen may be a clue to underlying amyloid.
Salmonella intracerebral and subdural abscess--report of two cases
Authors: Mahapatra A K , Bhatia R
Published: December 2008

Two cases of the rarely encountered Salmonella typhi subdural empyema are reported. The first was in an 11 month old infant and the second in a 25 year old adult. Neither of them suffered from typhoid fever. The causative organism was not suspected until the culture report was obtained. Both patients responded satisfactorily to therapy.
Amiodarone-induced pulmonary toxicity mimicking metastatic lung disease
Authors: Patel P , Honeybourne D , Watson R D S
Published: December 2008

A 65 year old man developed atrial arrhythmias secondary to a congestive cardiomyopathy which were resistant to quinidine and disopyramide. Amiodarone controlled the paroxysmal atrial tachycardia but 4 months after starting the drug he developed increasing dyspnoea and radiological changes highly suggestive of metastatic lung disease. Lung biopsy showed change of drug-induced pneumonitis and 4 months after stopping amiodarone his symptoms resolved and the chest X-ray had cleared. Amiodarone may cause pulmonary toxicity mimicking metastatic lung disease.
Granulocytic sarcoma: a diagnosis to be considered in unusual lymphoma syndromes
Authors: Mansi J L , Selby P J , Carter R L , Powles R L , McElwain T J
Published: December 2008

A series of 7 patients with granulocytic sarcoma is presented to illustrate its varied clinical picture. In particular, this condition may present with features which suggest a non-Hodgkin lymphoma. The diagnosis will only be made if a high index of suspicion is maintained and special histopathological methods are used. Granulocytic sarcoma should be treated like an acute myeloid leukaemia.
Crohn’s disease of late onset in Blackpool
Authors: Lee F I , Giaffer M
Published: December 2008

Fifty five (26%) of two hundred and fifteen patients presenting with Crohn’s disease in the Blackpool area over a 15 year period (1969-1983) were over 60 years of age. There were twice as many women as men (38:17). In 60% disease was limited to the large bowel compared to only 29% in the younger age group. Many of these were women with mild distal colitis. Twenty one patients required operative management. In general, the prognosis was good in colonic disease, but in small bowel and ileocolonic disease the necessity for early operative intervention was potentially fatal. Delayed diagnosis, poor nutritional state and associated disease were relevant adverse factors. The majority of patients at the time of review were well and, where necessary, were coping satisfactorily with a stoma.
The journal club and medical education: over one hundred years of unrecorded history
Authors: Linzer M
Published: December 2008

Sir William Osler organized a journal club at McGill University in 1875, and several authors suggest that journal clubs were found in certain European countries (in particular, Germany and England) prior to that time. The evolution and development of the journal club, however, has not been recorded in the medical literature. Through personal communications and interviews with senior clinicians and historians, I have traced the history of the journal club as an educational modality. In the early 1900s in Germany, journal clubs were routinely found in departments of medicine and medical schools. From 1917-1975, journal clubs evolved into a forum for continuing medical education. Recently, journal clubs have been designed to teach critical appraisal skills to physicians-in-training. Journal clubs are currently found in the fields of medicine, surgery, psychiatry, nursing, pharmacy, obstetrics and gynaecology, paediatrics and geriatric social service.

This powerful educational tool has played an active role in medical education for over a century. The journal club should be more formally incorporated into the medical educational curriculum.
Haemorrhage into a urachal cyst presenting as an ‘acute abdomen’
Authors: Davidson B R , Brown N J , Neoptolemos J P
Published: December 2008

A previously well 3 year old Asian girl presented as an emergency with the acute onset of generalized abdominal pain. On examination her abdomen was distended with generalized tenderness and guarding most marked centrally. Under anaesthesia a central abdominal mass arising from the pelvis was palpated which on proceeding to laparotomy was found to be a blood-filled urachal cyst. This was excised and her recovery was uneventful. Subsequent investigations have revealed no associated renal tract abnormalities.
Malakoplakia associated with adrenal and islet cell hyperplasia and glucagonoma
Authors: McClure John , Fairweather D S , Mene A R , Banerjee S S
Published: December 2008

Extensive involvement of the urinary tract and related structures by malakoplakia presented difficult diagnostic problems in two elderly individuals. At post-mortem examination there was bilateral adrenal cortical hyperplasia in both patients and, in one, there was also a pancreatic glucagonoma and diffuse hyperplasia of the pancreatic islet tissues. There is now an increasing body of evidence that malakoplakia is associated with hypercorticosteroidism possibly due to an effect on macrophage exocytotic mechanisms. The coexistence of malakoplakia and glucagonoma has not been previously described.
Abdominal tuberculosis in East Birmingham--a 16 year study
Authors: Sharp J F , Goldman M
Published: December 2008

Abdominal tuberculosis, although rare, occurs mainly in immigrants from the Indian subcontinent. Such people comprise 13.5% of our local population and contributed 90% of a series of 72 patients presenting in the last 16 years; a local disease incidence of 1:6000 for Asian immigrants.

Men and women were equally affected, but on average women were much younger. Diagnosis was made from one month to 10 years after immigration. No clinical feature was diagnostic, but abdominal pain, night sweats and weight loss occurred in more than half the patients. The erythrocyte sedimentation rate (ESR) was elevated in 95% and no patient tested had a negative Mantoux test. In 20 patients diagnosis was by clinical suspicion and response to therapeutic trial. In 52, including 39 who had a laparotomy, histological and culture material was obtained but these patients fared no better. Only one organism was resistant (to streptomycin) and rapid response to chemotherapy was the rule. Successful outcome was not related to the type of presentation, operative findings or specific chemotherapeutic agents.

We would suggest that in Asians presenting with difficult-to-diagnose abdominal symptoms accompanied by malaise, raised ESR and a positive Mantoux test, a therapeutic trial of anti-tuberculous therapy should precede diagnostic laparotomy.
Dystrophia myotonica and pregnancy--an instructive case
Authors: Chung H T , Tam A Y C , Wong V , Li D F H , Ma J T C , Huang C Y , Yu Y L , Woo E
Published: December 2008

Two cases of dystrophia myotonica, a mother and her newborn child, are reported. The diagnosis in the mother was only made after seven years and two eventful deliveries. The obstetrical and anaesthetic complications, as well as the neonatal form of dystrophia myotonica, are reviewed.
Systemic lupus erythematosus and primary cerebral lymphoma
Authors: Woolf A S , Conway G
Published: December 2008

A woman with a 21 year old history of systemic lupus erythematosus (SLE) is presented. During a period of low connective tissue disease activity she developed sudden difficulty in walking and after much investigation was found to have a primary lymphoma of the brain. She died 6 months after this diagnosis from meningeal spread, despite radiotherapy to the tumour. The association between SLE and lymphoma is discussed.
The use of a new glycopeptide antibiotic, teicoplanin, in the treatment of bacterial endocarditis
Authors: Webster A , Wilson A P R , Williams A H , Treasure T , Grüneberg R N
Published: December 2008

Teicoplanin, a new glycopeptide antibiotic, has been used to treat twelve patients with bacterial endocarditis due to Gram-positive organisms. Teicoplanin has activity against Gram-positive bacteria similar to vancomycin but therapeutic levels are maintained by a single daily dose, given as an intravenous bolus.

Of six patients with native valve infections, two cases, due to viridans streptococci, were successfully treated with teicoplanin alone and two others, caused by Streptococcus faecalis, were cured by combinations including teicoplanin. One of these patients sustained high tone hearing loss during treatment. The remaining two patients were drug addicts with endocarditis due to Staphylococcus aureus which recurred despite repeated multiple therapy. Of six prosthetic valve infections, antibiotic combinations including teicoplanin cured three cases, caused by streptococci. Infection persisted or treatment was curtailed in three cases of Staphylococcus epidermidis endocarditis.

In this small open study, teicoplanin appeared as effective as vancomycin in the treatment of endocarditis but had the considerable advantage of ease of administration.
Unusual causes of calf swelling--1. Unusual presentation of a tibial artery false aneurysm
Authors: Rowe P , Taylor P , Franklin A , McColl I , Missen A , Spencer J
Published: December 2008

Peripheral aneurysms of the leg are rare, and nearly always involve the popliteal artery. We describe the unusual presentation of a swollen leg caused by a large false aneurysm of a branch of the posterior tibial artery. This developed in the absence of either a history of trauma, local infection or infective endocarditis.
Unusual causes of calf swelling--2. Rhabdomyolysis mimicking deep vein thrombosis
Authors: Small M , Alzaid A , Gray H W
Published: December 2008

A 55 year old woman with pain and swelling of the leg was heparinized on the basis of a clinically diagnosed ilio-femoral deep vein thrombosis (DVT). Subsequent investigation showed her to have extensive rhabdomyolysis of the leg. Rhabdomyolysis can mimic the appearance of deep vein thrombosis and this case further illustrates the importance of venography in the assessment of the swollen leg.
Oculosympathetic paresis caused by foreign body perforation of pharyngeal wall
Authors: Bazak I , Miller A , Uri N
Published: December 2008

Ingestion of a foreign body rarely produces symptoms. We report a patient who presented with oculosympathetic paresis. We believe this is a previously unrecorded manifestation of foreign body ingestion.
Investigation of cereal toxicity in coeliac disease
Authors: Ciclitira P J , Ellis H J
Published: December 2008

Coeliac disease is exacerbated by wheat gluten. A review of methods for the purification, identification and quantitation of wheat proteins to investigate coeliac disease is presented. Recent developments including amino acid sequencing and expression of wheat protein peptides in E. coli should permit characterization of the cereal peptide that exacerbates coeliac disease.
Pulmonary berylliosis on corticosteroid therapy, with cavitating lung lesions and aspergillomata--report on a fatal case
Authors: O’Brien A A J , Moore D P , Keogh J A B
Published: December 2008

A fatal case of pulmonary berylliosis in a 42 year old male is described. The patient was exposed to beryllium while working in a chemical plant over a 9 year period, and presented two years after ceasing such employment. The berylliosis was diagnosed on open lung biopsy in 1971. The patient was commenced on steriod therapy at that time. He suffered progressive dyspnoea from severe restrictive lung disease over the next 14 years. A chest X-ray of June 1985 revealed a lesion in the left upper lobe suggestive of a mycetoma. Before any therapy could be instituted he suffered a massive haemoptysis and died. Post-mortem examination revealed two large mycetomata in the right and left upper lobes. Parenchymal histology showed evidence of chronic inflammation with non-caseating granulomata and the cavity wall showed localized invasion by Aspergillus fumigatus. It is possible that the long term steroid therapy with multiple boosters of treatment may have contributed to the development of the mycetoma. This is the first case report known to the authors of a fatal aspergilloma in association with chronic berylliosis treated with steroids.
Acute renal failure following Yersinia pseudotuberculosis septicaemia
Authors: Davenport A , O’Connor B , Finn R
Published: December 2008

Although Yersinia pseudotuberculosis has not been previously reported to cause acute renal failure, it accounted for two cases reported here out of eighty referrals with acute renal failure to our renal unit over the last year. This may suggest that the incidence of Yersinia pseudotuberculosis may be greater than that previously reported, and it should be suspected in patients presenting with bloody diarrhoea in association with renal failure. The septicaemic form of the disease is life threatening and requires intensive supportive therapy.
Fatty retroperitoneal tumours--plain film and computed tomographic appearances
Authors: Fitzgerald E J , Lyons K
Published: December 2008

Three patients with large fatty retroperitoneal tumours are presented. In all three the fatty mass was visible (but initially not recognized as such) on plain abdominal radiographs. Computed tomography (CT) confirmed the presence of fat within these tumours. Attention is drawn to the importance of the correct interpretation of the plain abdominal radiograph when such fatty tumours are present. Computed tomography then proves the presence of fat as well as site of origin of such tumours.
Gastric angiodysplasia--a missed cause of gastrointestinal bleeding
Authors: Tung K T , Millar A B
Published: December 2008

We report a case of severe chronic iron deficiency anaemia secondary to blood loss from gastric angiodysplasia. The clinical features, diagnosis and management of this uncommon condition are discussed.
Severe reversible cardiac failure associated with methanol intoxication
Authors: Cavalli A , Volpi A , Maggioni A P , Tusa M , De Pieri G
Published: December 2008

Methanol intoxication produces a well recognized clinical picture characterized by gastrointestinal, ocular and nervous system symptoms. The effect of poisoning on the cardiovascular system has not been well documented. We report the case of a 55 year old man whose acute methanol intoxication caused severe reversible cardiac failure. This represents the first description of an association between methanol toxicity and acute cardiac dysfunction in man.
Is the current use of thyroid scintigraphy rational?
Authors: Tindall H , Griffiths A P , Penn N D
Published: December 2008

One hundred and thirty-one consecutive requests for thyroid scintigraphy were analysed to assess their diagnostic contribution to the subsequent medical management of the patient. Forty one per cent of requests were to investigate the presence of a clinically detectable solitary nodule and, of these, one fifth had hot nodules. Diffuse goitres accounted for 38% of all referrals, but in only two patients (non-toxic hot nodule) did the results change management. A further 11% of referrals were for multinodular goitres and 8% for retrosternal goitres. In all cases of goitre no additional useful information was obtained from scintigraphy. It is concluded that thyroid scintigraphy was an unnecessary investigation in approximately 45% of cases. Its primary role was in the investigation of the solitary nodule and in detecting toxic nodules in thyrotoxic patients who had no evidence of Graves’ disease. Greater discrimination of requests would avoid investigating patients unnecessarily and reduce costs.
Ectopic Cushing’s syndrome with periodic hormonogenesis--a case suggesting a pathogenetic mechanism
Authors: Estopiñán V , Varela C , Riobo P , Dominguez J R , Sancho J
Published: December 2008

We report on a case of ectopic Cushing’s syndrome due to a thymic carcinoid tumour with periodic hormonogenesis. Periods of hormonal production averaged 27 days. Prior to bilateral adrenalectomy, mean (s.d) values of ACTH and cortisol were 202.1 (50.3) pg/ml and 46 (14.7) micrograms/dl, ACTH rising to 3996 +/- 425 pg/ml (P less than 0.01) and cortisol falling to 6.3 +/- 1.5 micrograms/dl (P less than 0.01) in the immediate postoperative period. During the late postoperative period (2-13 months following surgery) ACTH levels fell to 509.3 (123.8) pg/ml (P less than 0.01), but remaining even higher (P less than 0.01) than before adrenalectomy. The pattern of ACTH in the present case suggests the existence of a negative feedback exerted by the cortisol over tumoral ACTH.
Prolonged post-operative bleeding due to an acquired von Willebrand syndrome
Authors: Kinsey S E , Ryder K O , Machin S J
Published: December 2008

Acquired von Willebrand syndrome is a rare cause of post-operative bleeding, and should be considered in all such cases, in spite of previous uneventful surgical challenge.
Clostridium difficile, sulphasalazine, and ulcerative colitis
Authors: Burke D A , Axon A T R
Published: December 2008

Clostridium difficile has been implicated in the relapse of ulcerative colitis. Controversy exists over this role and its relationship to sulphasalazine exposure. Sixty two of 77 patients with a documented relapse of ulcerative colitis were investigated for the presence of Clostridium difficile, or its toxin, prior to hospitalization. There was a low incidence of detection which was related to antibiotic exposure (2/62). Sampling during the treatment period showed that the occurrence of Clostridium difficile in the stool was related to antibiotic treatment (2/66). Fifty six percent of patients were taking sulphasalazine, none of whom became culture or toxin positive. This study demonstrates that Clostridium difficile is not related to relapse of ulcerative colitis and is not secondarily acquired during relapse unless the patient is exposed to antibiotics. Sulphasalazine does not predispose to acquisition of Clostridium difficile. There is no role for routine screening or treatment of Clostridium difficile in ulcerative colitis.
Comparison of flupirtine and indomethacin on frusemide-induced diuresis
Authors: Johnston A , Warrington S J , Turner P , Riethmuller-Winzen H
Published: December 2008

A single oral dose of flupirtine maleate, a novel analgesic agent, did not antagonize significantly the diuretic action of frusemide when compared with indomethacin and placebo in normal human volunteers.
Hypernatraemia due to a reset osmostat for vasopressin release and thirst, complicated by nephrogenic diabetes insipidus
Authors: Thompson C J , Freeman J , Record C O , Baylis P H
Published: December 2008

We describe a patient with chronic hypernatraemia (plasma sodium 148-155 mmol/l) and partial nephrogenic diabetes insipidus who had received prolonged lithium treatment. Despite stopping the drug for one year the abnormalities remained. Infusion of hypertonic saline (NaCl 855 mmol/l) allowed the characterization of osmoregulation of thirst and vasopressin secretion. Linear regression analysis of plasma vasopressin and osmolality defined the function, pAVP = 0.27 (pOsm - 301), and analysis of thirst measured by a visual analogue scale and plasma osmolality, the function, thirst = 0.16 (pOsm - 302) where pAVP and pOsm represent plasma arginine vasopressin and osmolality respectively. The slopes of the regression lines which describe the sensitivity of the osmoreceptors were within the normal range, but both abscissal intercepts, which define the thresholds for vasopressin release and thirst, were markedly elevated in comparison to normal (upper limit less than 290 mOsm/kg). Other investigations of electrolytes, anterior pituitary function and high definition computed tomographic scanning of hypothalamo-pituitary region were all normal.

We conclude that this patient’s chronic hypernatraemia was due to resetting of the osmostats for both vasopressin release and thirst, a rarely described mechanism to account for hypernatraemia. Although it is probable that the partial nephrogenic diabetes insipidus was related to prolonged lithium therapy, the cause of the reset osmostats remains unclear.
Acute mastitis; a novel presentation of relapsing polychondritis
Authors: Haigh R , Scott-Coombes D , Seckl J R
Published: December 2008

A 30 year old female with previous Crohn’s disease presented with recurrent cutaneous vasculitis and polyarthritis. She subsequently developed recurrent transient bilateral mastitis with auricular and laryngotracheal chondritis typical of relapsing polychondritis. Acute mastitis is a previously unrecognized association of this disorder.
Renal replacement therapy in patients aged over 60 years
Authors: Tapson J S , Rodger R S C , Mansy H , Elliott R W , Ward M K , Wilkinson R
Published: December 2008

The availability of dialysis for patients with end-stage renal failure in the United Kingdom has lagged behind that in most of the rest of Europe and USA, although there has been considerable improvement over recent years. Concern about prognosis and quality of life on renal replacement therapy, together with shortage of facilities has meant that some elderly people have been denied treatment. A retrospective study of all patients commencing renal replacement therapy in Newcastle between 1974 and 1985 was performed. The five year survival of patients aged more than 60 years at the start of treatment (n = 122) was 53%, compared with 68% for a cohort of individuals aged less than 60 years (n = 632). A questionnaire sent to the 62 elderly patients surviving at the end of the follow-up period revealed that most were married, independent, active and lived in their own home. They were not lonely, generally enjoyed life and were happy with their mode of renal replacement therapy. These results show that elderly patients make good dialysis candidates and they should not be denied treatment on the basis of age alone. Greater funding of renal services is necessary to accommodate these patients.
The treatment of Guillain-Barré syndrome by modified plasma exchange--a cost effective method for developing countries
Authors: De Silva H J , Gamage R , Herath H K N , Karunanayake M G S , Peiris J B
Published: December 2008

Six patients with the Guillain-Barré syndrome were treated by modified plasma exchange. Five of them showed a rapid improvement which was not consistent with the natural history of the disease. The improvement was assessed by monitoring vital capacity and muscle power, grading the ability to perform motor functions and by the duration of the hospital stay. The method of plasma exchange we used was simpler and cheaper than the conventional method. We recommend the use of our method, especially in developing countries with financial constraints and poor facilities.
Cerebellar syndrome in sarcoidosis
Authors: Fuller G N , Guiloff R J
Published: December 2008

A 63 year old woman who presented with a cerebellar syndrome was shown to have sarcoidosis of the central nervous system, skin and liver with no pulmonary involvement.
Isolated angiitis of the brain in a young female on the contraceptive pill
Authors: Nagaratnam N , James W E
Published: December 2008

The case of a 15 year old girl with a rapidly progressing right sided hemiparesis is reported. The history and clinical manifestations were suggestive of either herpes simplex encephalitis or occlusion of the left middle cerebral artery. At necropsy an occlusive thrombosis of the left middle cerebral artery due to a segmental necrotizing granulomatous panarteritis was found. The cause was obscure. A plausible incriminating factor was the contraceptive pill.
Japanese encephalitis--an important cause of acute childhood encephalopathy in Lucknow, India.
Authors: Kumar R , Mathur A , Kumar A , Sharma S , Saksena P N , Chaturvedi U C
Published: December 2008

Eighty-six randomly selected children between 6 months and 12 years of age admitted with acute unexplained encephalopathy over a one year period were examined for evidence of Japanese encephalitis. One or more indicators of the infection were present in 36 (41.8%). Viral isolation from brain tissue was possible in 2 of 12 patients and from cerebrospinal fluid in 19 out of 62 patients. Serological evidence of probable Japanese encephalitis was found in 21 out of 36 patients. Japanese encephalitis is an important cause of acute childhood encephalopathy in the Lucknow area, where it is probably endemic.
Hypocalcaemia in autoimmune haemolytic anaemia and pernicious anaemia
Authors: Baba A A , Maharaj D
Published: December 2008

A 71 year old woman presented with hypocalcaemia in association with autoimmune haemolytic anaemia and pernicious anaemia. The hypocalcaemia resolved only when the haemolytic anaemia and pernicious anaemia were successfully treated. The possible pathogenic mechanisms are discussed.
Early onset high grade dysplasia in ulcerative colitis
Authors: Clements D , Suarez V , Thompson H , Alexander-Williams J , Allan R N
Published: December 2008

We report a patient with ulcerative colitis who underwent colectomy when aged 25 years for multifocal high grade dysplasia which had developed within 2 years of diagnosis, and only 5 1/2 years after his first symptoms. The implications of this case for the management of ulcerative colitis are discussed.
Mesenteric fibromatosis with ureteric stenosis.
Authors: Hailemariam S , Jaeger P , Goebel N , Grant J W
Published: December 2008

We report a case of a 37 year old man who presented with vomiting and colicky abdominal pain and who was found to have microscopic haematuria. Radiological-examination showed a right hydronephrosis apparently caused by a paracaecal tumour extending to involve the right ureter. This was resected and proved histologically to be a mesenteric fibromatosis. The patient has none of the factors predisposing to the development of this lesion, in particular Gardner’s syndrome. Eight months following surgery he appears to have made a full recovery. Previous publications on this rare intra-abdominal neoplasm are reviewed.
Unusual presentation of culture positive brucellosis
Authors: Jayakumar R V , Al-Aska A K , Subesinghe N , Wright S G
Published: December 2008

We have reviewed the clinical presentation of 100 consecutive culture positive cases of brucellosis which came under our care during the last two years. Of these, six had atypical presentations and but for the routine practice of sending blood for brucella culture, the diagnosis would have been missed. The unusual presentations included a 19 year old boy presenting as an acute abdomen ending in laparotomy, a 52 year old man presenting with a psoas abscess, a 29 year old woman presenting with a transient perinephric mass, a 75 year old man with an acute flare up of his osteoarthritis, a 65 year old diabetic man presenting in an insulin-resistant diabetic state and a 35 year old man presenting with a cauda equina syndrome.
Transient global amnesia and left frontal haemorrhage
Authors: Jacome Daniel E , Yanez Gonzalo F
Published: December 2008

A patient developed spontaneous, acute, dominant frontal lobe haemorrhage neighbouring on a zone of pre-existing post-traumatic encephalomalacia manifesting clinically as transient global amnesia. Amnesia can be secondary to disease of the frontal lobe, affecting pathways interconnecting the basal forebrain and hippocampus of the temporal lobe.
Spontaneous intraperitoneal rupture of the bladder in association with transitional cell carcinoma
Authors: Budd J S
Published: December 2008

A 79 year old woman presented with generalized peritonitis and was subsequently found to have a perforated bladder secondary to a tumour. This is a rare occurrence and a difficult diagnosis to make preoperatively.
Effects of captopril in patients with chronic obstructive pulmonary disease and secondary pulmonary hypertension
Authors: Patakas D , Georgopoulos D , Rodini H , Christaki P
Published: December 2008

Ten patients with chronic obstructive pulmonary disease (COPD) with normal left ventricular function were given a single dose of captopril (0.25 mg/kg). Mean systemic arterial pressure, heart rate and coronary flow to the right ventricle were reduced significantly after captopril. In contrast captopril did not cause a significant fall in pulmonary arterial pressure or pulmonary vascular resistance. We conclude that captopril fails to produce haemodynamic benefits in such hypoxic patients and that angiotensin II is not playing a significant role in maintaining pulmonary vasoconstriction.