bluuebunny/crossref_metadata_2025 huggingface dataset:
Fatal intrahepatic cholestasis associated with triazolam
Authors: Cobden I , Record C O , White R W B
Published: December 2008

A 44-year-old man developed severe pruritus with jaundice which subsequently proved fatal. Liver histology showed intense cholestasis, but at post-morten the bile ducts were patent and there was no cirrhosis, the findings being consistent with a cholestatic drug reaction. The most likely precipitant was the benzodiazepine triazolam, and surveillance is indicated for any further reactions to this recently marketed hypnotic.
Vascular disease in West Indian and white diabetics in Britain and Jamaica
Authors: Cruickshank J K , Alleyne S A
Published: December 2008

Cardiovascular complication rates among matched groups of black and white diabetics in England were compared with those among black diabetics in Kingston, Jamaica. Raised or uncontrolled blood pressure (≥ 160/95 mmHg) was common in all groups but diastolic hypertension was more severe in black patients. Despite this, clinical evidence of myocardial ischaemia was significantly more common in whites when compared with blacks in both centres but no such differences were found in peripheral vascular disease. Cataracts were much more frequent, and background retinopathy was slightly although not significantly commoner, in black patients. Complication rates were not correlated with cigarette smoking which was greatest in black men in Birmingham.

The diagnosis and continuous control of hypertension remains a major goal in diabetes.
Ethnic differences in respiratory disease
Authors: Jackson S H D , Bannan L T , Beevers D G
Published: December 2008

Hospital admission statistics from a district general hospital for patients aged 30-59 years over a 6-year period were analysed. There were 40 034 admissions excluding obstetrics. The overall distribution by place of birth was 9·2% West Indies, 13·5% Asia and 71·9% Northern Europe. This distribution was compared with the distributions for 4 groups of respiratory diseases. There were highly significant differences between these distributions for each diagnostic category. Asthma and respiratory tuberculosis were very much more common amongst Asians whilst West Indians suffered very little carcinoma of bronchus or bronchitis. Data collected from a factory screening showed that cigarette smoking could not account for these differences.
Cerebellar cortical degeneration with ovarian carcinoma
Authors: Steven M M , Mackay I R , Carnegie P R , Bhathal P S , Anderson R M
Published: December 2008

A case is described of progressive cerebellar degeneration in association with ovarian carcinoma, with nearly 4 years elapsing between the onset of neurological illness and the discovery of the carcinoma. Neither treatment with prednisolone nor surgical removal of the tumour effected any improvement, CAT scanning late in the illness showed marked cerebellar atrophy. Histology at post-mortem showed complete loss of cerebellar Purkinje cells. The cerebrospinal fluid gave weak binding to multiple neural components in a solid-phase radio-immuno-assay.
Primary adenocarcinoma of the duodenum associated with cutaneous neurofibromatosis (von Recklinghausen’s disease)
Authors: McGlinchey J J , Santer G J , Haqqani M T
Published: December 2008

A case of primary adenocarcinoma of the duodenum in a 29-year-old man with neurofibromatosis (von Recklinghausen’s disease) is described. As far as can be ascertained, such an association has not been described before.
A case of coconut bezoar and Meckel’s diverticulum
Authors: Lawrence R E
Published: December 2008

A 23-year-old male, operated upon for supposed pelvic appendicitis, was found to have a Meckel’s diverticulum with intestinal obstruction due to a coconut bezoar.
Tranexamic acid therapy in ulcerative colitis
Authors: Hollanders D , Thomson Jean M , Schofield Phillip F
Published: December 2008

The antifibrinolytic drug tranexamic acid was assessed in controlling bleeding in 12 patients with left-sided proctocolitis. The study was designed as a double-blind cross-over trial employing a dose of 4·5 g of tranexamic acid/day together with identical placebo. A statistically significant reduction in rectal bleeding was achieved in 50% of cases with a minimum of side effects. Sigmoidoscopic grading of rectal mucosal appearances was improved. Frequency of diarrhoea and stool consistency were not altered.

Tranexamic acid may have a part to play in the management of selected patients with ulcerative colitis in whom bleeding is difficult to control with orthodox treatment.
Assessment and management of acute asthma in the elderly: a comparison with younger asthmatics
Authors: Petheram Ian S , Jones D A , Collins J V
Published: December 2008

Assessment on admission and responses to treatment were studied in 20 patients aged 65 years or over admitted with severe acute exacerbations of asthma and were compared with patients aged 40 years or less who were managed similarly. The elderly asthmatic had less marked tachycardia and pulsus paradoxus compared to the younger group for similar degrees of airways obstruction and arterial blood gas abnormalities. Assessment confined to physical examination would, therefore, have underestimated the severity of their asthma. The rates of improvement in airflow obstruction were similar in both young and old but those elderly patients who had required maintenance oral corticosteroids were less likely to reach their predicted peak expiratory flow rate (PEFR) than their peers or younger patients.
Metastatic hypernephroma of the parotid gland
Authors: Percival R C , Curt J R N
Published: December 2008

A case of metastatic hypernephroma of the right parotid gland is reported. The case presented two years before developing symptoms of her hypernephroma. The metastasis was unaffected by excision of the primary hypernephroma.
Fast growing goitre as the first clinical manifestation of systemic amyloidosis
Authors: Amado J A , Palacios S , Manzanos J , Ondiviela R , Casanova D , Freijanes J
Published: December 2008

A case of systemic amyloidosis presenting as a fast growing goitre is reported. There was neither clinical nor biochemical evidence of hepatic, cardiac or renal involvement, in contrast with previously reported cases. Despite large deposits of amyloid in the thyroid the clinical and biochemical studies demonstrated a normal thyroid function.
Oral theophylline in chronic heart failure
Authors: Al-Damluji S , Johnston A , Spurrell R A J , Nathan A W , Banim S O , Camm A J
Published: December 2008

Theophylline choline 600 mg was given as a single oral dose to nine patients in chronic left ventricular failure due to myocardial dysfunction. Cardiac output, left ventricular filling pressure (LVFP) and right atrial pressure (RAP) were measured with a pulmonary artery thermodilution catheter for the following 3 hr. Continuous recordings of cardiac rhythm were made throughout the study. Mean cardiac index increased from 1·75 (±0·14 s.e. mean) to 2·04 (±0·11) 1/min/m2 (P<0·02), mean LVFP fell from 27 (±2·4) to 22 (±1·5) mmHg (P<0·01), mean RAP fell from 5 (±1·3) to 3 (±2·0) mmHg (P<0·05) and mean systemic arterial pressure rose from 80 (±3) to 86 (±3·5) mmHg (P<0·05). There were no significant changes in heart rate or systemic vascular resistance; thus the increase in cardiac output was probably due to a positive inotropic effect. Side effects were seen in two patients, both of whom proved to have toxic plasma theophylline concentrations.

This study demonstrated a beneficial acute haemodynamic effect of oral theophylline in chronic cardiac failure.
Leiomyosarcoma of the inferior vena cava. A case report with a review of the literature
Authors: Adeyemi E O , Schejbal V
Published: December 2008

A patient with leiomyosarcoma of the inferior vena cava is reported and a total of 65 cases is reviewed.
Dystonia associated with carbamazepine toxicity
Authors: Bradbury A J , Bentick B , Todd P J
Published: December 2008

An uncommonly reported toxic effect of carbamazepine is a dystonic reaction. We report two children who developed dystonic reactions with toxic serum levels of carbamazepine.
Chronic autoimmune thrombocytopenic purpura associated with haemophilia A
Authors: Mulholland Michael W , Edson J Roger , Delaney John P
Published: December 2008

Two patients with haemophilia A developed chronic autoimmune thrombocytopenic purpura. Because of the increased risk of haemorrhage, splenectomy was recommended. Successful operative management included daily infusions of missing clotting factors with monitoring of blood levels in the postoperative period.
A single dose comparison of a combination of fenoterol and ipratropium aerosols in bronchial asthma
Authors: Lawford P , Palmer K N
Published: December 2008

Nine patients with reversible obstructive airways disease were studied to compare the bronchodilator response to a combination of fenoterol and ipratropium aerosols with two dose levels of fenoterol alone.

Using a double-blind, cross-over, single dose regime, 200 micrograms fenoterol hydrobromide and 80 micrograms ipratropium bromide was compared to 400 micrograms fenoterol + placebo, and to 200 micrograms fenoterol + placebo.

There was no significant difference between the combination and either dose of fenoterol in terms of peak or duration of response as determined by absolute or percent change in forced expiratory volume in one second, or forced vital capacity, over baseline.
Blood dyscrasias and mianserin
Authors: Adams P C , Robinson A , Reid M M , Vishu M C , Livingston M
Published: December 2008

Four cases are described in which the drug mianserin was implicated in the development of leucopenia. In one case this was accompanied by fatal aplastic anaemia. In a second, generalized bone marrow depression occurred, although leucopenia was the only clinically significant manifestation. Mianserin may depress bone marrow function and haematological surveillance is appropriate for patients taking this drug.
Abnormalities of gut vessels in Turner’s syndrome
Authors: Reinhart Walter H , Mordasini C , Stäubli M , Scheurer U
Published: December 2008

We describe a 57-year-old patient with Turner’s syndrome, iron deficiency anaemia and intestinal vascular abnormalities. Colonoscopy revealed 2 widely dilated, tortuous veins in the terminal ileum and several smaller ectatic veins and haemangioma-like malformations throughout the colon. Laparotomy for herniotomy showed only minimal vascular abnormalities of the serosal surface. Patients with Turner’s syndrome and anaemia should be checked for these lesions by endoscopy, and conversely, in patients with such lesions, Turner’s syndrome should be considered.
Capillary blood collecting system for glucose determination
Authors: Wiles Philip G , Watkins Peter J
Published: December 2008

A method of self collection of blood is described for use by diabetic patients unable, or unwilling, to determine their own blood glucose, and for when accurate results are required for research purposes.

A commercially available ‘flask’ capillary blood collecting system can be used to collect 50 microliters blood for glucose determination on a Yellow Springs analyser. The results are accurate when compared to Auto Analyzer (r = 0.988) and are unaffected by storage at 4 degrees C for up to 28 days (r = 0.988). This system is easily available, readily accepted by patients, and the method consumes minimal laboratory time.
Pancreatic polypeptide and calcitonin secretion from a pancreatic tumour-clinical improvement after hepatic artery embolization
Authors: Manche A , Wood S M , Adrian T E , Welbourn R B , Bloom S R
Published: December 2008

We present a case in which plasma pancreatic polypeptide and calcitonin were found to be raised in association with an islet cell tumour of the pancreas and its hepatic metastases. In this patient, no specific endocrine syndrome was found. Therapeutic hepatic artery embolization improved the general health of the patient with no change in plasma pancreatic polypeptide, but a fall in calcitonin.
Metastatic renal carcinoma presenting with profuse haemorrhage at cardiac surgery
Authors: Wood A J , Wood J R , Corrin B , Paneth M
Published: December 2008

A 62-year-old man undergoing coronary artery bypass grafting sustained profuse unexplained haemorrhage during sternal diathermy before sternotomy. Histology of tissue from the sternum suggested metastatic renal carcinoma. A primary renal tumour was subsequently identified. Sternal metastases are rare, often highly vascular, and arise particularly from thyroid or renal tumours. In the absence of angiographic evidence of an eroding aortic aneurysm, sternal metastases represent the most likely cause of unexplained haemorrhage during sternotomy.
Alpha heavy chain disease developing in an Asian resident in the United Kingdom and responding to antibiotics
Authors: Ross I N , Thompson R A , Asquith P
Published: December 2008

A 40-year-old man born in Bangladesh developed alpha heavy chain disease whilst a resident in the United Kingdom. An incomplete, low molecular weight alpha heavy chain protein, devoid of light chains was demonstrated in his serum. Clinical remission of his disease was achieved by antibiotics alone.
Leiomyosarcoma of the spermatic cord
Authors: de Bolla A R , Arkell D G
Published: December 2008

Leiomyosarcoma of the spermatic cord is extremely rare. We report a case associated with recurrent papillary bladder tumours and benign hyperplasia of the prostate. The use of adjuvant chemotherapy is described for the first time in the management of this condition.
The Birmingham blood pressure school study
Authors: De Giovanni J V , Pentecost B L , Beevers D G , Beevers M , Jackson S H D , Bannan L T , Osbourne V L , Mathews K
Published: December 2008

Four-hundred and twenty-eight school leavers of 3 ethnic groups (white, black and Asian) were screened for blood pressure, resting pulse rate and general anthropometric characteristics. Asian pupils were both shorter and lighter than the other two groups whilst black males were heavier and taller. There was no significant difference in the mean systolic or diastolic blood pressure between the 3 groups, although the black pupils had a stronger family history of hypertension, particularly on the mother’s side. These observations differ in some respects from other ethnic blood pressure studies and establish values for the local population.
Liver abscess caused by Haemophilus parainfluenzae
Authors: Chattopadhyay B , Silverstone P H , Winwood R S
Published: December 2008

A case of liver abscess caused by Haemophilus parainfluenzae in an otherwise healthy adult is described which responded to medical management without surgery. This we believe to be the first reported case of liver abscess caused by this organism in the English medical literature.
Sideroblastic anaemia associated with lincomycin therapy
Authors: Kokkini G , Tsianos E , Kappas A
Published: December 2008

Sideroblastic anaemia developed after lincomycin therapy in a 58-year-old woman. The anaemia proved completely reversible after termination of lincomycin therapy and the introduction of pyridoxine. The patient also had pseudomembranous enterocolitis, a well-known side effect of lincomycin.
Life style and national and international trends in coronary heart disease mortality
Authors: Marmot M. G.
Published: December 2008

An international comparison of trends in mortality from coronary heart disease (CHD) since 1968 shows a sizeable decline in the U.S.A., Australia, New Zealand, Finland, Canada, Belgium and Japan. By contrast England, Wales and Scotland had shown no evidence of decline in CHD mortality until 1979. This has resulted in a marked deterioration in the CHD ranking of Scotland and England and Wales relative to other countries. Sweden, Hungary, Poland, Yugoslavia, Bulgaria, Rumania and the U.S.S.R. have all had increases in CHD mortality. There are many possible reasons for these changes. In general, countries that had had a decrease in CHD mortality have experienced changes in the type and/or quantity of fat in the national diet. The changes in CHD mortality in Sweden and Japan are out of line with the pattern in other countries. There is some evidence that changes in smoking and blood pressure control may have contributed to changes in CHD mortality. Changes in physical activity may have also played a part.
Spinal cord compression by extramedullary haematopoiesis in myelofibrosis
Authors: Crawford D. C. , Nightingale S. , Bates D. , Tomlinson B. E.
Published: December 2008

A 50-year-old man with a 20-year history of myelofibrosis developed mild impairment of dorsal column sensation and ataxia of gait. A myelogram and subsequent peroperative biopsy demonstrated spinal cord compression due to extramedullary haematopoiesis. There was an excellent clinical response to surgery and radiotherapy. The characteristic clinical features and the pathogenesis of this unusual complication of myelofibrosis and extramedullary haematopoiesis are discussed.
Ulcerative colitis treated by excision of the distal large bowel alone
Authors: Nakano G. , Ritchie J. K. , Thomson James P. S.
Published: December 2008

Four patients with ulcerative colitis apparently limited to the rectum and distal sigmoid colon were treated by excision of the distal large bowel only, during the years 1964–1975 at St Mark’s Hospital. Two patients have remained well since with no further treatment and the other two have had symptoms of colonic disease and have responded to medical measures.
Cimetidine therapy does not prevent rebleeding from peptic ulceration
Authors: Carr-Locke D. L. , Taverner D. , Wicks A. C.
Published: December 2008

One-hundred and five patients admitted to hospital with symptoms of acute upper gastrointestinal haemorrhage shown at endoscopy to be due to peptic ulceration were entered into a prospective double-blind controlled trial of cimetidine versus placebo therapy. The trial therapy was commenced within 12 hr of admission and continued for 7 days. Cimetidine therapy made no difference to the transfusion requirements, rebleeding rate or number of operations performed in patients with either gastric or duodenal ulcers, nor was it of benefit in patients aged over 65 years of age.
Complete rectal prolapse—the results of Ivalon sponge rectopexy
Authors: Anderson J. R. , Wilson B. G. , Parks T. G.
Published: December 2008

Forty-two patients with complete rectal prolapse have been treated using the Ivalon sponge rectopexy. There was no operative mortality in this series and only one complete recurrence after an average follow-up of more than 4 years. Pelvic sepsis occurred in one patient and required removal of the sponge. The majority of the patients were satisfied with the results of surgery, despite some remaining incontinent.
Severe repetitive exercise and haematological status
Authors: Ross J. H. , Attwood E. C.
Published: December 2008

The effects of severe repetitive exercise on certain haematological measurements were studied. Decreases in haematocrit and haemoglobin (13% in one group of participants) took place during the first 2 weeks but not the third week of increasingly severe exertion and the reasons for this are discussed. Haemolysis probably plays only a small part and plasma volume expansion is likely to be the main cause of this phenomenon. It is suggested that there is no stimulus for the haemoglobin concentration to be increased to match the increased plasma volume as tissue oxygen tension is maintained satisfactorily.
Twice-daily cimetidine does not increase gastric bacterial flora
Authors: Bourne J. T. , Mountford R. A. , Barry R. E.
Published: December 2008

Thirty patients with peptic ulcer (20 duodenal, 10 gastric) underwent glucose-hydrogen (H2) breath tests before and after 6 weeks treatment with cimetidine, 400 mg twice daily. For the group as a whole, basal breath H2 and integrated H2 output over a 2.5 hr test period was unchanged by cimetidine treatment. We conclude that there was no evidence of significant gastric bacterial colonization following twice daily cimetidine treatment.
An unusual cause of variceal haemorrhage in an elderly patient
Authors: Somerville K. W. , Boyd R. V. , Ansell I. D. , Williams C. B. , Bell G. D.
Published: December 2008

An elderly patient with nodular regenerative hyperplasia of the liver and hypothyroidism who presented with life-threatening bleeding from oesophageal varices is discussed. Progress has been uneventful following a semi-emergency portocaval shunt 5 years ago with no evidence of hepatic encephalopathy. This is presumably a tribute to the relatively well-preserved hepatic function in this condition.
Immuno-reconstitution by thymic transplant in DiGeorge’s syndrome
Authors: Daga S. R. , Siddiqui H. M. , Lokhande M. P. , Chandrashekhar L. , Prabhu P. G. , Kansaria B. N.
Published: December 2008

Persistent hypocalcaemic tetany in a breast-fed neonate made us suspect DiGeorge’s syndrome, particularly as the baby had an abnormal facies, and a ventricular septal defect. Immuno-reconstitution was successfully achieved by thymic transplant. Evidence of immuno-reconstitution on the basis of the histology of the post-transplant thymus has not been previously recorded.
Marrow failure with sideroblasts in an autoimmune haemolytic crisis
Authors: Allison M. C. , Jeha M. T.
Published: December 2008

We report a case of autoimmune haemolytic anaemia complicated by ineffective erythropoiesis associated with florid sideroblastic change in the bone marrow.
A study of two diuretic/potassium combinations in heart failure
Authors: Hussain M , Walton K , Davidson C , Morgan D B
Published: December 2008

The effect of potassium supplements was studied in 28 patients taking long term frusemide (40-80 mg daily). Plasma potassium fell when supplements were stopped, and rose towards prior values on the potassium/frusemide combination, Diumide K. In a crossover study in 14 of these patients comparing equivalent doses of frusemide, Diumide K (frusemide 40 mg, potassium 8 mmol), bumetanide, and Burinex K (bumetanide 0.5 mg, potassium 7.7 mmol) plasma potassium was lower on frusemide than on bumetanide. On Diumide K and Burinex K plasma potassium rose significantly but did not reach the levels on prior therapy. Small doses of potassium in combined formulations seem to be effective in countering the mild hypokalaemia caused by loop diuretics.
Enophthalmos as a rare manifestation of metastatic orbital involvement
Authors: de Keyser J , Bruyland M , de Greve J , Bernheim J , Ebinger G
Published: December 2008

Two cases in which orbital metastasis produced enophthalmos, instead of the usual exophthalmos, are reported. Only fourteen other cases have been described previously and they are reviewed. At time of diagnosis of the enophthalmos, meningeal carcinomatosis coexisted in the first case and probably also in the second case. This association can lead to diagnostic errors with either the orbital metastasis or the meningeal carcinomatosis being missed. In addition, as in our second case, the enophthalmos can be the initial manifestation of cancer.
Coexisting primary hyperparathyroidism and Albright's hereditary osteodystrophy—an unusual association
Authors: Sasaki H , Tsutsu N , Asano T , Yamamoto T , Kikuchi M , Okumura M
Published: December 2008

Primary hyperparathyroidism associated with Albright's hereditary osteodystrophy was diagnosed in a 22 year old Japanese woman, the second such case to be reported. Albright's hereditary osteodystrophy (AHO) appears to be associated with a larger number of disorders than the well recognized pseudohypoparathyroidism. AHO and pseudo-pseudohypoparathyroidism are essentially identical.
Perforated gastric ulcer
Authors: Wilson-Macdonald J , Mortensen N J McC , Williamson R C N
Published: December 2008

Thirty-four patients presenting with gastric perforation over a ten year period were studied, retrospectively. Five patients (14%) died either as a result of delay in treatment or wrong diagnosis. In addition, 2 patients (6%) died from postoperative complications. Twelve patients (38%) were on potentially ulcerogenic drugs. Patients who had either simple closure of ulcers (n = 17) or partial gastrectomy (n = 6) had few symptoms at follow-up, but patients who underwent truncal vagotomy and pyloroplasty (n = 7) had poorer results. There were 2 recurrent ulcers following simple closure.
Tolerability of combined treatment with verapamil and beta-blockers in angina resistant to monotherapy
Authors: McGourty J C , Silas J H , Solomon S A
Published: December 2008

We have used a combination of a beta-blocker and verapamil to treat 42 consecutive patients with angina resistant to either agent alone. Patients with heart failure, heart block or uncontrolled hypertension were excluded. The mean duration of follow-up was 6.5 months. Thirty-six patients (81%) reported an improvement and the number of angina attacks was reduced from 17/week to 5/week. Side effects necessitated withdrawal of one or both drugs in 6 patients, 2 of whom developed bradyarrhythmias not solely related to drug treatment. The most common complication was mild left ventricular failure (6) treated by reducing or stopping the beta-blocker. The data suggest that the combination of verapamil and a beta-blocker may be used in a relatively unselected group of patients with difficult angina. However, as dosage adjustment and close observation may be necessary to minimise side effects, the use of this combination should be limited to hospital practice.
Hormonal and biochemical responses to transcendental meditation
Authors: Cooper R , Joffe B I , Lamprey J M , Botha A , Shires R , Baker S G , Seftel H C
Published: December 2008

This study was designed to assess whether transcendental meditation (TM) could influence various endocrine responses in 10 experienced male meditators. Nine matched subjects, uninformed of the TM procedure, acted as controls. Meditators successfully practised their technique for 40 min in the morning while controls relaxed for this period. No significant differences emerged between these 2 groups with respect to carbohydrate metabolism (plasma glucose, insulin and pancreatic glucagon concentrations), pituitary hormones (growth hormone and prolactin) or the ‘stress’ hormones, cortisol and total catecholamines-although meditators tended to have higher mean catecholamine levels. Plasma free fatty acids were significantly elevated in meditators 40 min after completing the period of TM. No clear evidence was thus obtained that any of the stress, or stress-related, hormones were suppressed during or after meditation in the particular setting examined.
Low molecular weight measles immunoglobulin M in subacute sclerosing panencephalitis and acute measles
Authors: Connolly J H , Simpson D M , Trudgett A , Hopkins A P
Published: December 2008

Thirty eight patients with subacute sclerosing panencephalitis (SSPE) were investigated. Five patients who previously had measles immunoglobulin M (IgM) detected in unfractionated serum and cerebrospinal fluid (CSF) had measles IgM exclusively in the low molecular weight (LMW) fractions of serum and CSF. Measles IgM had previously not been found in unfractionated serum from 33 patients but was detected exclusively in the LMW fractions of serum from 30 patients. Seven children with acute measles had the expected high molecular weight (HMW) measles IgM in serum but 5 also had LMW measles IgM. Four young adults who had had measles in childhood had neither HMW nor LMW measles IgM in their sera.
Isolated adrenocorticotrophic hormone (ACTH) deficiency associated with acute adrenal crisis
Authors: Jialal I , Desai R K , Maharaj I C , Pala A S , Joubert S M
Published: December 2008

A 37 year old black female presented with congestive cardiac failure, 2 months postpartum. She developed spontaneous hypoglycaemia and symptoms of acute adrenal crisis (hypotension, nausea, abdominal pain and tachycardia with small thready pulse), which responded to i.v. dextrose, sodium chloride and hydrocortisone. Biochemical investigations revealed low serum cortisol and plasma adrenocorticotrophic hormone (ACTH) levels. The patient initially showed an impaired cortisol response to intramuscular aqueous tetracosactrin, but an exuberant response after priming with intramuscular tetracosactrin depot. These findings, together with the normal remaining pituitary function, led us to conclude that this patient had isolated ACTH deficiency associated with congestive cardiac failure and acute adrenal crisis.
Painful dysphagia in a case of mediastinal tuberculous lymphadenopathy
Authors: Ghimire M P , Walker R J
Published: December 2008

A patient with mediastinal tuberculous lymphadenopathy is described. Presentation was with rapid onset of painful dysphagia following trauma to the neck. Early diagnosis was achieved by mediastinoscopy.
Repeat pituitary ablation for advanced prostatic cancer
Authors: Khan O , Allen J , Williams G , Mashiter K , Joplin G F
Published: December 2008

An elderly male patient with advanced prostatic adenocarcinoma, requiring increasing analgesia, underwent interstitial pituitary irradiation by implantation of yttrium-90. He was temporarily relieved of his pain. Assessment of his anterior pituitary function showed only partial ablation. He therefore underwent a second implantation. This achieved complete ablation, and only when this was achieved did he experience full and sustained pain relief. We recommend assessment of anterior pituitary function in patients treated by pituitary ablation for carcinoma of the prostate, and especially in those in whom the disease progresses after initial success response.
Pleomorphic T-cell leukaemia in a Caucasian adult: clinical phenotypic and functional characteristics
Authors: Hawkey C J , Campbell A C , Bird G A , Gozzard D I , Robins R A , Toghill P J
Published: December 2008

Pleomorphic T-cell leukaemia occurring in an adult Caucasian patient is described. The leukaemia cells expressed both antigenic determinants (T4 and T8) normally detected separately on either helper or suppressor cells. They functioned as helper cells and there was evidence of unbridled antibody production. It is possible that a distinctive subtype of pleomorphic T-cell leukaemia occurs in Caucasian patients.
Myocardial infarction and the normal arteriogram—possible role of viral myocarditis
Authors: O'Neill D , McArthur J D , Kennedy J A , Clements G
Published: December 2008

In a prospective study we identified a group of 12 patients diagnosed as having acute myocardial infarction but with electrocardiographic features of non-transmural infarction and serological evidence of recent Coxsackie B infection favouring the possibility of myocarditis. The group included 9 females and 3 males, aged from 38–60 y. Coronary arteriography was carried out in 11 patients. Eight of the 11 patients showed no significant (≥ 50%) coronary arterial obstruction.

We suggest that coronary artery disease did not contribute to the clinical presentation in the majority of these patients and that the likely diagnosis was viral myocarditis in at least 6 of them. We conclude that viral myocarditis may simulate myocardial infarction and contribute to the uncommon but controversial syndrome of myocardial infarction with a normal coronary arteriogram.
Dopamine in the pituitary adaptation to starvation in man
Authors: Jung R T , Rosenstock J , Wood S M , Birch G , Chalmers R A , Mashiter K , Joplin G F
Published: December 2008

To investigate the role of the dopaminergic system in the pituitary adaptation to energy deprivation, the effect of metoclopramide, a dopamine receptor blocker, on prolactin (PRL), TSH, FSH and LH secretion was investigated in 6 healthy men in the fed state and at 36 h starvation. All underwent a further 36 h of starvation on a separate occasion to assess the effect of starvation on the TSH and PRL responses to TRH and the LH and FSH responses to gonadotrophin releasing hormone (GnRH). In all subjects starvation produced the expected reduction in serum T3 and an average decrease of 53% in the cumulative TSH response to TRH. The basal serum PRL and its response to TRH and metoclopramide remained unchanged with 36 h starvation. The FSH response to GnRH also remained unchanged, but the LH response was significantly greater during starvation. We conclude that factor(s) other than dopamine influence not only thyrotrophic activity but also other aspects of pituitary function during energy deprivation.
Galactorrhoea amenorrhoea syndrome due to internal carotid artery aneurysm
Authors: Garg S K , Dash R J
Published: December 2008

A 32 year old female with hyperprolactinaemia-galactorrhoea-amenorrhoea due to a right internal carotid artery aneurysm just before its bifurcation is described. She had two episodes of subarachnoid haemorrhage necessitating an emergency internal carotid artery ligation. She responded to bromocriptine treatment with restoration of her menses, normalization of circulating prolactin and disappearance of galactorrhoea.
Coexistent ulcerative colitis and Crohn's disease
Authors: Jones B J M , Gould S R , Pollock D J
Published: December 2008

This case report describes a patient with chronic ulcerative colitis and epithelial dysplasia of 17 y duration ultimately complicated by colonic carcinoma. At laparotomy, clinically unsuspected but typical Crohn's disease of the terminal ileum was also found. The macroscopic and histological features of the resected terminal ileum were characteristic of Crohn's disease.
Severe aplastic anaemia following the use of hair dye: report of two cases and review of literature
Authors: Hopkins J E , Manoharan A
Published: December 2008

We describe two female patients aged 31 and 62 y who developed severe aplastic anaemia following the use of hair dye containing para-toluenediamine. One received a bone marrow transplant but died after developing graft versus host disease and severe opportunistic infection. The second responded to treatment with methylprednisolone, oxymetholone and antithymocyte globulin and 3 y later she has a normal blood count apart from mild thrombocytopenia.

In this paper we also review previously described case reports of aplastic anaemia apparently associated with the use of hair dye.
Acute acalculous cholecystitis due to an incarcerated epigastric hernia
Authors: Goldman G , Rafael A J , Hanoch K
Published: December 2008

A case of a 96 year old woman with an incarcerated gallbladder in an epigastric hernia causing acute acalculous cholecystitis is described. At operation the gallbladder was replaced in its anatomical site and the hernia was repaired. This unique case of acute acalculous cholecystitis demonstrates cystic duct obstruction and cystic vessel compression as possible aetiologies for this pathology.
Conjugate deviation of downgaze in the toxic shock syndrome
Authors: Dick D J , Harvey R D , Hudson S J , Walls T J
Published: December 2008

A patient with the toxic shock syndrome presented with conjugate deviation of downgaze and impaired ocular movement. Focal neurological signs are rare in this syndrome and disordered eye movement has not been previously reported.
The use of lumbar puncture in a district general hospital
Authors: Oliveira D B G
Published: December 2008

A survey of lumbar punctures performed in adults in a district general hospital over a two year period was carried out. As well as being used for conventional, specific indications, lumbar puncture was often employed as a screening investigation in undiagnosed neurological illness. Although this was not inappropriate in patients with meningeal symptoms and signs, or patients with disordered consciousness, lumbar puncture was also used in patients with focal neurological signs. Although the dangers of lumbar puncture in these latter patients, and the fact that it is unlikely to yield information unobtainable by other investigations have been stated by many authorities, almost 20% of patients fell into this group. This suggests that these points require further emphasis.
Idiopathic periodic hypothermia and bizarre behaviour in the presence of occult syringomyelia
Authors: Gray H H , Smith L D R , Moore R H
Published: December 2008

Overt psychological, neurological and haematological abnormalities were present in a 35 year old Jamaican female diagnosed as having idiopathic periodic hypothermia. Although symptoms and signs were ameliorated by warming, no long term satisfactory therapeutic measure was identified. Despite extensive clinical and subsequently histological investigation no cause for the hypothermia was found although she had clinically unsuspected cervical syringomyelia.
Full thickness rectal prolapse associated with primary intraabdominal pathology
Authors: Banerjee A K , Jackson B T , Nicholls R J
Published: December 2008

Full thickness rectal prolapse as a presenting feature of occult intraabdominal disease is rare. Two such cases are described and the possible mechanisms discussed. The importance of adequate investigation is emphasized.
Protein losing enteropathy as a sole manifestation of non-Hodgkin's lymphoma
Authors: Konar A , Brown C B , Hancock B W , Moss S
Published: December 2008

We describe a patient who presented with oedema and hypoproteinaemia which was proved to be due to protein-losing enteropathy. Extensive gastrointestinal investigations failed to discover any definitive cause. He subsequently developed tuberculous inguinal lymphadenopathy but although treated for tuberculosis the protein-losing state persisted. Later on he developed renal failure due to obstructive nephropathy. Laparotomy was carried out and it disclosed the diagnosis of non-Hodgkin's lymphoma, treatment of which cured the protein-losing state.
Septum of the gallbladder, clinical implications and treatment
Authors: Deutsch A A , Englestein D , Cohen M , Kunichevsky M , Reiss R
Published: December 2008

We report four patients with a congenital gallbladder septum whose symptoms resembled those of cholelithiasis, in one case giving rise to acute cholecystitis. Cholecystectomy relieved symptoms in all cases and examination of the operative specimen confirmed the clinical diagnosis and X-ray findings. Ultrasonography made a positive diagnosis in the last two cases and no stones were found in any of the cases described. Cholecystectomy is advocated in symptomatic patients with this condition, even when gallstones are not present.
Antibodies to the thyroid gland and to the thyrotrophin receptor in African and Indian thyrotoxic patients
Authors: Desai R K , Jialal I , Omar M A K , Rajput M C , Joubert S M
Published: December 2008

Sixty two thyrotoxic patients, 34 African and 28 Indian, were studied in order to assess the prevalence of thyroid antibodies and TSH binding inhibitory activity (TBI): 45 had Graves' disease and 17 had toxic nodular goitres. Microsomal and thyroglobulin antibodies were positive more often in Indian than in African patients with Graves' disease (microsomal 52% vs 37.4%, P < 0.05; thyroglobulin 38.1% vs 4.2%, P < 0.001). Patients with toxic nodular goitres had a lower prevalence of positive microsomal antibodies (P < 0.01), but not of thyroglobulin antibodies (P = 0.1) when compared with patients with Graves' disease. TBI activity measured by a radioreceptor assay was positive in 43 of the 45 (95%) patients with Graves' disease and only 1 of the 17 patients (5.9%) with toxic nodular goitre. It thus appears that TBI activity is a sensitive marker in the diagnosis of Graves' disease and that there is a lower prevalence of thyroglobulin and microsomal antibodies in African patients compared with Indian patients.
Persistent local insulin allergy in a diabetic with chronic lymphatic leukaemia
Authors: Winocour P H , Haeney M
Published: December 2008

A 75 year old maturity-onset diabetic developed persistent local allergy to insulin. She had coexistent asymptomatic chronic lymphatic leukaemia. All species of insulin provoked a recurrence of the allergy and attempts at hyposensitization and treatment of the leukaemia produced only marginal benefit. Administration of subcutaneous steroids with insulin relieved the problem, but could not be stopped without relapse. Immunological investigations suggested an immune complex-mediated hypersensitivity reaction to insulin. The later development of immune complex-mediated arthropathy tended to support this suggestion. The lack of histological and immunological evidence of an IgE-mediated reaction suggested that in this case the mechanism of insulin allergy and arthralgia was IgG mediated. We suggest that the chronic leukaemia was implicated in both processes by interfering with homeostatic mechanisms that normally prevent the development of autoallergic disorders.
Multilocular cyst of kidney
Authors: Narasimharao K L , Mitra S K , Pathak I C
Published: December 2008

We describe a child with a multilocular renal cyst who presented with a renal mass and pain due to haemorrhage into the cyst. This type of presentation has not been reported previously.
Rational preoperative evaluation
Authors: Muskett A D , McGreevy J M
Published: December 2008

Clinical data from two hundred consecutive patients undergoing surgical procedures at the Salt Lake City VA Hospital form the basis of this study. Results of nine commonly ordered preoperative tests (blood count, differential, electrolytes, chemistry panel, urinalysis, prothrombin time, partial thromboplastin time, electrocardiogram, and chest X-ray) were matched with the preoperative history and physical examination and the outcome of surgery in each patient. Each test was examined by the frequency with which it was ordered, the frequency with which it was abnormal, and the frequency with which the abnormal result affected preoperative care. A prevalence of medical illness was found in this population, with 47.5% having a major cardiovascular diagnosis, 35.5% a metabolic or endocrine disease, and 28% a major pulmonary diagnosis.

A total of 1271 tests were performed, with 477 (35.5%) showing some abnormality. However, only 76 (5.9%) changed the patient's management before surgery. All but five of these abnormalities were predictable from the clinical evaluation and these five were minor. The overall postoperative complication rate was 9%. No complication was attributed to the omission of a preoperative test. No surgical cases were cancelled during the study period based solely on a preoperative test. We conclude that many preoperative tests can be safely eliminated by ordering only those based on a specific abnormality in the history or physical examination, resulting in more cost-effective surgical care.
Another family with acute vitamin D intoxication: another cause of familial hypercalcaemia
Authors: Thomson R B , Johnson J K
Published: December 2008

Acute vitamin D intoxication from an unknown source occurred in a family consisting of a grandmother, mother, father and four children aged 14, 11, 8 and 1 1/2 years old. The clinical presentation and response to treatment (which included a diphosphonate preparation and cholestyramine) are described.
Crohn's disease in monozygotic twins
Authors: Rampton D S , Stott R B
Published: December 2008

A pair of monozygotic twins with Crohn's disease is described. Both have ileocaecal disease and suffered their first symptoms after living apart for 6 years. The pathogenic role of hereditary and environmental factors is discussed in the light of this and previous reports of twins with Crohn's disease.
Sarcoidosis presenting as multiple pulmonary nodules and nephrotic syndrome
Authors: Vidal F , Oliver J A , Campanya E , Baguer A , Carrera M , Richart C
Published: December 2008

A 56 year old man presented with thrombophlebitis, nephrotic range proteinuria and multiple pulmonary nodules. A renal biopsy showed membranous glomerulonephritis, and after a thoracotomy a diagnosis of sarcoidosis was established.

A pulmonary nodular pattern is unusual in sarcoidosis and is often mistaken for malignant disease. The association of this type of pulmonary involvement and membranous glomerulonephritis as the presenting form of sarcoidosis has not previously been described.
Fatal hyperparathyroid crisis
Authors: Keeling C A , Abrahamson M J , Harloe D G J
Published: December 2008

A case of hyperparathyroid crisis presenting with a serum calcium level of 7.6 mmol/l is presented. The rarity and importance of recognizing the condition early is emphasized.
Nitrite-induced methaemoglobinaemia
Authors: Walley T , Flanagan M
Published: December 2008

Three patients developed methaemoglobinaemia after eating meat contaminated with excessive nitrites. Diagnosis was delayed in the first two mild cases but was promptly made in the third most severely affected case.
Intraventricular haemorrhage complicating a brain abscess
Authors: Pascual J , Diez C , Carda J R , Vázquez-Barquero A
Published: December 2008

Intraventricular haemorrhage occurred in a patient with a parietal rim-enhancing mass on computed tomographic scan. At operation a brain abscess was identified and removed. Peptostreptococcus and fusobacterium were isolated, possibly of dental origin. The possible sources of this intracranial bleeding are discussed. A neoplasm should not always be considered in the case of a cerebral ring-enhancing mass complicated with intracranial bleeding; in selected cases, brain abscess should be excluded too.
Tetany despite normocalcaemia and normomagnesaemia following parathyroidectomy
Authors: Fonseca V A , Bloom R D , Dick R , Dandona P
Published: December 2008

Two patients with long-standing hyperparathyroidism due to a parathyroid adenoma are described. Both had severe osteitis fibrosa cystica and a proximal myopathy. Both were treated with alfacalcidol (2 micrograms/day) prior to and following parathyroidectomy, and infused with calcium gluconate following the operation. Plasma total and ionized calcium and magnesium concentrations were maintained within the normal range. However, both developed tetany in the postoperative period in spite of normal ionized calcium and magnesium concentrations. Tetany continued for 4 weeks in one patient and for longer in the other. Prolonged hypercalcaemia may result in a state of neuromuscular excitability following parathyroidectomy even at high normal concentrations of ionized calcium.
Prognostic indicators of septicaemia--a two year prospective evaluation
Authors: Iyer R P , Duckett G K , Brogan T D , Tweedy P S , Sharpe T C
Published: December 2008

The problem of septicaemia in a district general hospital was studied prospectively over a two year period, with respect to factors affecting prognosis. Age had little influence on the outcome, although several factors showed age-related trends which tended to be unfavourable to survival. The mortality among patients over 65 years of age was 39.5% and this was not significantly different from the mortality of 34.5% among those below that age. It is suggested that by taking into consideration simple clinical and laboratory findings like sex, source of infection, intercurrent illness, blood urea, pulse rate and temperature, it is possible to predict prognosis with reasonable accuracy without recourse to excessive expenditure of money or resources.
Climatic effects on blood pressure in normotensive and hypertensive subjects
Authors: Abdulla K , Taka M
Published: December 2008

In a retrospective within-patient study, the arterial pressures of 174 normotensive and 50 hypertensive subjects in winter and summer were compared. Both systolic and diastolic pressures were higher in winter in the two groups but the differences were small and reached statistical significance only in the case of systolic pressure in normotensive subjects.
Pseudotumour cerebri in a patient with Castleman’s disease
Authors: Black D A , Forgacs I , Davies D R , Thompson R P H
Published: December 2008

A patient with systemic Castleman’s disease (angiofollicular lymph node hyperplasia) including bone changes and peripheral neuropathy, is described. She also had pseudotumour cerebri, and, as this association has been reported previously, it is unlikely to be due to chance.
Hyperaldosteronism combined with hypercortisolaemia in a patient with adrenal carcinoma
Authors: Panesar N S , Tsao S Y , Wheeler M J , Cockram C S
Published: December 2008

A patient with adrenal carcinoma who initially presented with features suggestive of Conn’s syndrome, but subsequently was shown to produce excess cortisol and other steroids, is described.