bluuebunny/crossref_metadata_2025 huggingface dataset:
The irritable bowel syndrome, single sex representation and birth order
Authors: McaLlister C , Fielding J F
Published: April 2023

Single sex representation and birth order in 100 patients with the irritable bowel syndrome (IBS) were determined and compared with those of 100 age and sex matched controls. Single sex members, in families with three or more children, were significantly more frequent in IBS. There was a trend for more IBS sufferers to be at the extremes of sibling constellation, particularly the youngest, but this did not reach statistical significance. These findings have not been previously reported.
Ascites associated with gross hypothyroidism
Authors: Robinson T J
Published: April 2023

Diseases of the liver and thyroid can frequently co‐exist, and abnormalities in one organ can be accompanied by disturbances in laboratory tests reflecting dysfunction of the other1,2. The autoimmune diseases, such as thyroiditis, have been described as occurring with hepatitis or cirrhosis3 and abnormal thyroid function tests, implying thyrotoxicosis can occur in cirrhosis and, in particular, in patients with alcoholic liver disease 4,5. It would appear that treatment of thyrotoxicosis will usually bring liver function tests back to normal6. Hypothyroidism has been associated with abnormal levels of creatinine kinase, lactic dehydrogenase, aspartic transaminase, but these enzyme rises probably arise from muscle7. Significant reversible liver abnormality occurring with hypothyroidism does not appear to have been reported before and the following report suggests there could be an association.
Pyopneumopericardium — a complication of gastro‐oesophageal surgery
Authors: Bonser R S , Brewin E G
Published: April 2023

Pyopneumopericardium is a rare condition. It can occur as a result of penetrating external chest trauma or penetrating injury via the oesophagus. It can also occur as a consequence of inflammatory or malignant disease in neighbouring organs1,2. Spontaneous penetration of gastric ulcers, oesophagitis and gastric cancer into the pericardium have been reported3,4,5,6. Here we describe a case occurring as a complication of gastro‐oesophageal surgery for benign disease which was managed conservatively.
Fractures of the lower vertebral column in ankylosing spondylitis
Authors: Straiton N
Published: April 2023

Patients with ankylosing spondylitis are susceptible to spinal fractures. We report two such patients who developed neurological signs following their injury. Practitioners caring for patients with ankylosing spondylitis should be aware that cord damage following a vertebral fracture, is common in such patients.
Premature menopause: three teenage cases
Authors: Dunham A
Published: April 2023

Three cases of premature ovarian failure at a very early age (two patients aged 16 and one aged 18) are reported. All presented with secondary amenorrhoea. The diagnosis was made after the finding of greatly raised serum FSH and LH levels and confirmed at laparoscopy and biopsy of the ovary, when a tiny uterus with atrophic ovaries was seen. Ovarian biopsy showed a lack of primordial follicles. All three patients are on hormone replacement therapy.
Mondor's disease and breast cancer
Authors: Hershman M J , Archer M J
Published: April 2023

Mondor's disease, superficial thrombophlebitis of the breast, is universally regarded as a benign, self‐limiting condition. We report a case in which Mondor's disease is associated with pre‐operative breast cancer.

We recognise the generally benign course of Mondor's disease, but emphasise that its presence does not exclude malignancy.
Treatment of peptic ulcer in general practice and in hospital: a comparison of omeprazole and cimetidine
Authors: Davis R Harvard , Stott N C H , Barber J H , Freeling P , Peers E M , Richardson P D I
Published: April 2023

The aim of this study was to compare duodenal ulcer healing and symptom relief after two and four weeks treatment with omeprazole or cimetidine in groups of patients treated in general practice and as hospital out‐patients.

It was a randomised, double‐blind, parallel group study with stratification for trial centre (hospital or GP). Endoscopy was performed at entry, after two weeks and, if unhealed at two weeks, after four weeks. All endoscopies were carried out in hospitals.

In all. 189 patients were randomised (98 omeprazole, 91 cimetidine), 79 (42 percent) of which by GPs, to either omeprazole 20 mg om (n=41) or cimetidine 800 mg nocte (n=38) for two to four weeks.

After two weeks, ulcer healing occurred in 56 percent (omeprazole) and 29 percent (cimetidine) (p<0.05) of patients treated by GPs, and 67 percent (omeprazole) and 36 per cent (cimetidine) (p<0.005) of those treated as hospital out‐patients. Similar differences in healing rates were seen alter four weeks.

Omeprazole produces faster duodenal ulcer healing than cimetidine whether patients are treated as hospital out‐patients or by GPs.
Non‐steroidal anti‐inflammatory drugs and gastrointestinal bleeding in the elderly
Authors: Sahi S P , Basu S K , Bansal S K
Published: April 2023

Cases of gastrointestinal bleeding associated with non‐steroidal anti‐inflammatory drugs (NSAIDs) were analysed. Forty per cent of the 92 cases admitted with gastrointestinal bleeding were found to be on NSAIDs. Sixty per cent of the cases on NSAIDs had a preceding history of dyspepsia or ulcer disease and its complications. Forty per cent presented with spontaneous bleeding. We discuss some of the aspects of the management of these cases in clinical practice.
Routine pre‐operative electrocardiography
Authors: McCleane G J , McCoy E
Published: April 2023

In a study of 877 patients presenting for anaesthesia with an ECG, 45 per cent of the ECGs were found to be abnormal. The incidence of abnormal ECGs was found to be highest in the over‐40 age group, and also in those patients of ASA Grades II, III, IV and V, and this investigation is therefore recommended in these patients.
Intractable epilepsy
Authors: Bwala S A , Gardner‐Thorpe C
Published: April 2023

A 26‐year‐old female had her first partial seizure at the age of five years. Further seizures occurred and later became generalised in nature. Control of the seizures became difficult despite the use of nine different anticonvulsants over a period of 20 years. She was not suitable for neurosurgical intervention because of the diffuse nature of her seizures. Cerebellar stimulation had only a marginal effect on seizure frequency. With time she became mentally retarded and was unable to benefit from formal education. Her illness demonstrates many of the long‐term clinical features and management problems of intractable epilepsy.
Efficacy of ceftizoxime in the treatment of uncomplicated gonorrhoea: comparison with amoxycillin
Authors: Veeravahu M , Clay J C , Mohanty K C , Tovey S J , Wanas T M , Roberts K N
Published: April 2023

Four centres contributed a total of 466 patients to a study comparing the efficacy of oral amoxycillin with that of probenecid and intramuscular ceftizoxime. Both treatments were equally efficacious, except in the small number of penicillinase‐producing Neisseria gonorrhoeae patients, all of whom responded to ceftizoxime and none to amoxycyllin. Both treatments were well tolerated, the only two adverse effects occurring in the ceftizoxime group.
Lymphocyte transformation in elderly non‐insulin‐dependent diabetics before and after improved glycaemic control
Authors: Winocour P H , Lenton J , Puxty J A H , Anderson D C
Published: April 2023

Mitogen‐induced lymphocyte transformation was examined in 23 elderly patients with poorly controlled Type II diabetes before and after achieving improved glycaemic control with sulphonylureas and compared with 11 healthy controls of similar age. No difference between groups was seen after incubation of lymphocytes with phytohaemagglutinin (PHA). Lymphocyte transformation after 10 μg/ml concavalin A (con A) was significantly greater in diabetic patients after improved control and when compared to healthy controls (p<0.025). The response to 5 μg/ml and 10 μg/ml pokeweed mitogen (PWM) was greatest in diabetic patients after effective metabolic control.
Combined endoscopic cytology and biopsies in the diagnosis of duodenal malignancy
Authors: King A J W , McCabe J , Waldron M , Kerin M J , McGuire M , Given H F
Published: April 2023

The value of combined cytohistochemical examination in the diagnosis of malignant duodenal lesions was assessed in 78 patients with suspicious duodenal lesions seen at endoscopy. Cytological smears were taken using the direct‐vision brushing technique and all were processed by the same experienced cytologist. Duodenal malignancy was confirmed histologically in four patients. Endoscopic biopsy was positive for malignancy in three of the patients and cytology was suspicious of malignant change in two patients and positive for malignant change in one patient. Cytology alone confirmed the diagnosis of malignancy in one patient. The cumulative diagnostic yield using both biopsy and cytology was 100%.
Mitral valve prolapse in a patient with epidermolysis bullosa
Authors: Banerjee A K
Published: April 2023

Mitral valve prolapse has been assoicated with several connective tissue and developmental disorders, including Ehlers‐Danlos syndrome, Marfan's disease; pseudo‐xanthoma elasticum, myotonic dystrophy. cardiomyopathy, Ebstein's anomaly of the tricuspic valve and atrial septal defect of the ostium secundum variety. Presented here is a case of mitral valve prolapse in a patient with epidermolysis bullosa. The author is unaware of any previously reported cases of this association.
Group G streptococcal septic arthritis
Authors: Rady M , Turner P G , Ross E R S
Published: April 2023

The Lancetleld group G streptococcus is known to be a cause of serious infective illness. However, few cases of septic arthritis are recorded. Only one report of this infection, following total joint replacement, has appeared in the orthopaedic literature.1 Here we describe a further case of infection in a previously normal joint that presented with unusual clinical findings and radiographic changes. We stress the importance of accurate bacteriological investigation and aggressive treatment.
Repair of infected defects of the chest wall by transposition of greater omentum
Authors: Wening J V , Thoma G , Emmermann A , Zornig C
Published: April 2023

Myocutaneous flaps have a firm role in the reconstruction of soft tissue defects.1 Furthermore the supply of extremely infected defects of the chest wall with involvement of the ribs is problematic, especially in irradiated regions. The use of the omental transposition flap is an alternative to the latissimus dorsi myocutaneous flap in treatment of such a deficiency associated with necrosis of the ribs and uncovered pleura.2,3 The authors have used this method successfully on eight patients. The scope of this technique is not confined to the chest wall. It can also be extended to defects of the region of the axilla and other parts of the body. For checking the extension and constitution of the greater omentum pre‐operatively a laparoscopy under local anaesthesia is always carried out. All patients seen by the authors experienced primary healing of the omentum and chest wall.
Abolition of electrocardiographic pattern of left ventricular aneurysm by posterior myocardial infarction
Authors: Lim R , Wilson D T R
Published: April 2023

We report a patient who presented with prominent gastrointestinal symptoms in whom a confident clinical diagnosis of acute posterior myocardial infarction was facilitated because the fresh electrocardiographic changes of true posterior myocardial infarction abolished the old pattern of left ventricular aneurysm. This interesting electrocardiographic phenomenon has not, to our knowledge, been previously reported.
Intestinal obstruction secondary to uterine perforation: an unusual cause of vaginal bleeding
Authors: Davies M F P , At J M T How
Published: April 2023

A patient with intestinal obstruction is described in whom small bowel was incarcerated within the uterine lumen. This is thought to have arisen as a result of undiagnosed uterine perforation during a previous dilatation and curettage.
Hypertension in the elderly: a study of a combination of atenolol, hydrochlorothiazide and amiloride hydrochloride
Authors: Duckett G K , Cheadle B
Published: April 2023

The anti‐hypertensive effects of atenolol (Tenormin) 50 mg, a potassium‐sparing diuretic (half‐strength Moduretic) comprising hydrochlorothiazide 25 mg plus 2.5 mg amiloride hydrochloride, and the ‘free’ combination of atenolol and diuretic were compared in elderly hypertensive patients aged 60‐79 years.

After a four‐week run‐in period on placebo, patients were randomly assigned, in a double‐blind manner, to atenolol or diuretic treatment, each for four weeks. Thereafter patients were given the ‘free’ combination for a further four weeks and this treatment was continued for six months.

Blood pressure and heart rate were measured after the patient had rested for five minutes supine and after two minutes standing. These blood pressure measurements were made at least 24 hours after the preceding dose using a Random Zero sphygmomanometer. Results from 26 of the 27 patients entered into the study showed an advantage for combination therapy combined with either atenolol or diuretic treatment alone.

No significant difference was found between treatments in the frequency of supraventricular and ventricular ectopic beats occurring in six patients who underwent 24‐hour ambulatory ECG monitoring. However, ectopic activity was reduced in some patients during beta‐blocker treatment.

Few adverse effects occurred with any treatment. Three patients withdrew during the placebo period and three withdrew while taking active treatment.

This study has shown that the combination of atenolol, hydrochlorothiazide and amiloride hydrochloride is an effective, safe, well‐tolerated antihypertensive drug regimen when used once daily in elderly hypertensive patients.
A comparative study of terfenadine at two dose levels in the management of hayfever
Authors: Stern M A , Rosenberg R M , Smith R , Fidler C
Published: April 2023

One hundred and twenty patients with hayfever were enrolled in a single‐centre, double‐blind crossover study designed to compare the efficacy and safety of terfenadine at doses of 60 mg bd and 120 mg bd. A two‐week placebo run‐in period was followed by the two treatment periods, each lasting two weeks. Assessments of hayfever symptoms were made daily by patients and at each clinic visit by the investigator. Adverse events were recorded at the end of each treatment period. At the end of the study both investigator and patient rated the overall efficacy and the patient recorded treatment preference. The data were examined by analysis of variance (ANOVA) for treatment, period and crossover effects. Pollen counts were recorded for the duration of the study.

Seventy‐four patients completed the study, the majority of withdrawals occurring during the placebo phase. There was no significant difference in symptom relief between the two doses of terfenadine. The number of adverse events, including drowsiness, was similar for the two treatments and for placebo. Mean and peak pollen counts both correlated well with symptom severity. These data show that terfenadine 60 mg bd is an adequate dose for the treatment of hayfever symptoms.
Pseudo‐pyloric tumours
Authors: Courtney Stephen P , Spicer Richard D
Published: April 2023

Two infants presenting with vomiting were thought to have palpable pyloric tumours. At operation hypertrophic pyloric stenosis was not present, but other conditions causing duodenal obstruction were, and these required surgical treatment. The cases illustrate that other abnormalities may masquerade as pyloric stenosis.
Mycotic aneurysm caused by Group B streptococcus: a cautionary tale of management problems and a rare organism
Authors: Burnet N G , Wilkinson R C , Evans D S
Published: April 2023

We report a case of mycotic aneurysm of the femoral artery which highlights the diagnostic features and management problems of the condition. Our patient required emergency ligation of the artery for life‐threatening haemorrhage and subsequently his leg was not viable. The alternative treatment options of simple ligation and excision versus ligation, excision and immediate bypass grafting of the artery are discussed.

The causative organism, beta‐haemolytic group B streptococcus (S. Agalactiae), is an extremely rare cause of embolic mycotic aneurysm. This rarity is unexplained and is surprising since this organism is a well‐known cause of infective endocarditis, which can be complicated by mycotic aneurysms.

Mycotic aneurysms may become more common because of the rise of intravascular drug abuse, which combines the risk factors of vessel trauma, endocarditis and immunosuppression, notably from HIV infection.
Thyrotoxicosis in a patient with Addison's disease
Authors: Casson I F , Walker B A , Hipkin L J
Published: April 2023

We report the case of a patient who suffered recurrent episodes of hypoadrenal crisis, despite conventional replacement therapy for Addison's disease. She was found to have hyperthyroidism and after this was treated, she had no further relapse. Thyrotoxicosis should be considered when patients taking replacement therapy for Addison's disease present in hypoadrenal crisis.
Aspiration pneumonia as a cause of death
Authors: Haleem M A
Published: April 2023

This study of aspiration pneumonia is based on postmortem examinations carried out over a decade from 1979 to 1988 at York, on subjects of all ages and both sexes. The purpose of this study was not only to analyse the autopsy findings, but also to find out the real prevalence, the major causes leading to aspiration pneumonia, and its associated clinical features.
MASSIVE HAEMORRHAGE IN PANCREATITIS
Authors: Owen T D , Davies D G L
Published: April 2023

SUMMARY Massive haemorrhage in pancreatitis is a very rare complication of pancreatitis but it is the most rapidly lethal, haemorrhage being the major cause of death in more than half of the fatal cases. We present three patients who illustrate this rare complication in its diversity of presentation, and advise that doctors should have a keen clinical awareness of this condition if there is to be an effective and expeditious management. An understanding of the condition, coupled with immediate treatment, using embolisation or laparotomy with direct ligation of the bleeding vessel, can be lifesaving.
JEJUNOSTOMY FEEDING FOR THE CONSERVATIVE MANAGEMENT OF SPONTANEOUS RUPTURE OF THE OESOPHAGUS
Authors: Salim A S
Published: April 2023

SUMMARY Three patients with spontaneous rupture of the oesophagus (Boerhaave's syndrome) were successfully treated by a conservative regimen consisting of nil orally and broad‐spectrum antibiotics, while their nutrition was satisfactorily maintained by jejunostomy feeding. Such a regimen is simpler and cheaper than one utilising parenteral nutrition: it avoids its complications and limitations, and will enable healing to take place within three weeks after the rupture has occurred. It is therefore suggested that the conservative management of Boerhaave's syndrome is the treatment of choice.
THE INCIDENCE OF ABDOMINAL AORTIC ANEURYSMS
Authors: Stevens K
Published: April 2023

SUMMARY The incidence of abdominal aortic aneurysms (AAAs) is increasing, especially in the elderly. This trend has been observed in the United Kingdom,1 USA,2 Australia,3,4 and Sweden5,6 The increase can be explained partly by an enhanced awareness of the condition and partly by the rising numbers of elderly in the population. In addition, improved diagnostic techniques have enabled earlier detection of aneurysms. But this does not fully explain why we are seeing such a high prevalence of the condition. Evidence for the increase can be obtained from a number of sources,7 such as routine mortality statistics.
TUBERCULOUS PERITONITIS PRESENTING AS COLOENTERIC FISTULA
Authors: Nair A , Patel R , Monypenny I J
Published: April 2023

SUMMARY Abdominal tuberculosis can present as tuberculous peritonitis with generalised or loculated ascites, lymphadenitis of the mesenteric or retroperitoneal nodes, or as intestinal tuberculosis. In the last case it could be annular mucosal ulceration, single or multiple strictures or hyperplastic tuberculosis of the bowel, usually involving the terminal ileum or ileocaecal region. Disease higher in the ileum is considered common but involvement of the appendix, stomach, duodenum, jejunum, colon and rectum is unusual. Tuberculous peritonitis presenting as a coloenteric fistula is not a common clinical entity. In this case a patient who presented with peritonitis was found to have tuberculous peritonitis with coloenteric fistula.
A RARE LATE COMPLICATION OF BREAST CANCER TREATMENT
Authors: Clements W D B , Kirk S J , Spence R A J
Published: April 2023

SUMMARY In 1948 Stewart and Treeves recognised and described six cases of lymphangiosarcoma arising in the oedematous upper limb of patients who had previously undergone radical mastectomy and radiotherapy for breast carcinoma.1 The incidence of lymphangiosarcoma in such patients is 0.45%2 and is uniformly aggressive and fatal, with a 5‐year survival of less than 5% regardless of the treatment modality.3 We present a case report to increase the clinical awareness of this rare and fatal iatrogenic complication occurring subsequent to breast cancer treatment, and speculate on ways of improving survival.
OBSTRUCTIVE JAUNDICE DUE TO INTRACHOLEDOCHAL BLOOD CLOT: AN UNUSUAL EARLY PRESENTATION OF PRIMARY HEPATIC CARCINOMA
Authors: Vagianos C , Karavias D , Dragotis C , Kalofonos H , Androulakis J
Published: April 2023

SUMMARY We report a case of early presentation of a hepatocellular carcinoma with obstructive jaundice, due to obstruction of the common bile duct by a blood clot. The possibility of preoperative diagnosis, the surgical treatment and the postoperative outcome are discussed.
THE INVESTIGATION AND MANAGEMENT OF GASTRO‐OESOPHAGEAL REFLUX DISEASE
Authors: Anggiansah A , Owen WA , Owen WJ
Published: April 2023

SUMMARY The authors review the important factors in the pathogenesis of gastro‐oesophageal reflux disease (GORD), explain how to avoid the pitfalls of oesophageal pH monitoring, and discuss the place of maintenance therapy and surgery in the management of the disease.
PNEUMOPERITONEUM DUE TO PCI IN A PATIENT WITH A STRANGULATED FEMORAL HERNIA
Authors: Kelly BE , Cooper GG , Mills JOM
Published: April 2023

SUMMARY Although pneumatosis cystoides intestinalis (PCI) is a well‐recognised condition, an individual surgeon is unlikely to encounter it often. The collected experience of two surgical units in Glasgow teaching hospitals over a 15‐year period consisted of five patients.1 Surgical and radiological trainees may therefore have little or no exposure to the diagnostic difficulties this condition can cause. We report an illustrative case.
MANAGEMENT OF INVASIVE ASPERGILLOSIS WITH ITRACONAZOLE
Authors: Hakim SM , Milne LJR , Fox C , Nawroz IM , Vaughan GT , Webb G
Published: April 2023

SUMMARYA case of chronic invasive paranasal aspergillosis is described which, despite an initial poor prognosis, responded well to treatment with itraconazole.
SYMPTOMATIC COLITIS AS THE INITIAL PRESENTATION OF WEGENER'S GRANULOMATOSIS
Authors: Wilson RH , Kerr PP , McLoughlin J , Gormley M
Published: April 2023

SUMMARY Wegener's granulomatosis is a multisystem disorder which rarely presents with gastrointestinal involvement. We report a case in which colitis was the reason for hospital admission. Diagnosis may be difficult unless clinical, serological and histopathological features are all considered.
EXERCISE, CARDIOVASCULAR DISEASE AND LIPIDS
Authors: MacAuley D
Published: April 2023

SUMMARY Epidemiological studies have demonstrated the considerable benefits of habitual vigorous activity, both at work and during leisure time. There are many benefits at all ages and for all levels of fitness, but particular emphasis is being placed on the cardiovascular benefits. Exercise may induce beneficial changes in lipid profile and thus reduce risk of cardiovascular disease. Lifestyle changes cost little, have few side‐effects, and are self‐administered. Increasing habitual physical activity is a form of lifestyle modification that can be tailored to all needs — a non‐therapeutic intervention of proven efficacy and of value to all patients.
DUAL‐CHAMBER PACING VIA A PERSISTENT LEFT SUPERIOR VENA CAVA IN A PATIENT WITH TURNER'S SYNDROME
Authors: Fuseini A , MacLoughlin P , Dewhurst NG
Published: April 2023

SUMMARY Persistent left superior vena cava often occurs with other cardiovascular malformations, and may complicate positioning of intravenous pacing electrodes. The previously unreported association with coarctation of the aorta and Turner's syndrome is documented in a 50‐year‐old patient needing a dual‐chamber pacemaker after the onset of complete heart block.
DELAY IN THE DIAGNOSIS OF OSTEOMYELITIS PUBIS
Authors: Packer GJ , Lennox CME
Published: April 2023

SUMMARY The pubis is an uncommon site for osteomyelitis, which fact may contribute to difficulty in establishing the diagnosis. Two cases of osteomyelitis pubis in children are presented in which the diagnosis and definitive treatment were delayed.
CAROTID SINUS HYPERSENSITIVITY IN PATIENTS REFERRED WITH POSSIBLE EPILEPSY
Authors: McCrea W , Findley LJ
Published: April 2023

SUMMARY Four patients with recurrent transient loss of consciousness, all of whom had previously undergone extensive non‐invasive cardiological investigations, were referred for neurological opinion. All were found to exhibit a resting bradycardia and a cardioinhibitory response to carotid sinus stimulation. All were referred for cardiological opinion but only two patients were considered by their respective cardiologists to warrant pacemaker implantation. Those who did not receive a pacemaker continue to suffer from their symptoms. The clinical management of these patients highlights an apparent divergence of opinion amongst cardiologists on the treatment of carotid sinus hypersensitivity and emphasises that, unless the ECG and blood pressure responses to carotid sinus stimulation are observed in patients with histories of unexplained episodes of altered consciousness, carotid sinus hypersensitivity will be missed as a possible cause of symptoms. The presence of unexplained bradycardia may suggest carotid sinus hypersensitivity.
THE PREVALENCE OF ANTI‐HCV POSITIVITY IN PATIENTS UNDERGOING HAEMODIALYSIS OR WITH MALIGNANT DISEASE
Authors: Paydas Sa , Aksu HSZ , Paydas Se , Burgut R , Sagliker Y
Published: April 2023

SUMMARY We studied the occurrence of anti‐hepatitis C (HCV) antibodies in patients with malignant disease (53), in patients undergoing haemodialysis (56), and in blood donors (204) as healthy population controls. The study was carried out using the second‐generation EIA test. Anti‐HCV positivity was 23.2% in haemodialysis (HD) patients, 0.5% in blood donors, and 0% of the patients with malignant disease (MD). There was no association between anti‐HCV positivity and the results of AST, ALT and HBsAg tests in patients and controls. But there was significant association of blood transfusion frequency and duration of HD with anti‐HCV positivity in patients undergoing HD, and conversely an absence of this association in patients with MD. However, two of the anti‐HCV‐positive HD patients did not have any blood transfusion history. One HCV‐positive blood donor had a history of surgical operation. Nosocomial transmission of HCV infection has replaced blood transfusion as the main risk factor in HD patients, and preventive measures should be performed in this direction to control infection.
PROBLEMS SOLVED AND LIVES SAVED? CHRONIC HEART FAILURE
Authors: McMurray J , Francis M
Published: April 2023

SUMMARY Chronic heart failure (CHF) is common, disabling and deadly. Recent studies show that ACE inhibitors reduce morbidity and mortality in all grades of CHF and may even delay or prevent the onset of overt CHF in patients with asymptomatic left ventricular dysfunction. In this review, guidelines are given for how to use these drugs both in hospital and in general practice. New evidence on the benefits of digoxin is also considered, and the management of concomitant problems such as angina and arrhythmias in patients with CHF is discussed.
NON‐TRAUMATIC RUPTURE OF SPLEEN IN ACUTE LYMPHOBLASTIC LEUKAEMIA
Authors: Merei' J , Marouf R , Behbehani A
Published: April 2023

SUMMARY A 30‐year‐old man newly diagnosed as having acute lymphoblastic leukaemia developed spontaneous splenic rupture during hospitalisation before initiation of antileukaemic therapy. He developed sudden shock and abdominal ultrasound was diagnostic. Laparotomy confirmed the ultrasound findings, and a splenectomy was performed.
IBUPROFEN‐INDUCED THROMBOCYTOPENIA
Authors: Jain S
Published: April 2023

SUMMARY Ibuprofen is a non‐steroidal analgesic and anti‐inflammatory drug widely used in current medical practice. After a thorough search of the literature I found no well‐documented case of severe thrombocytopenia following its therapeutic use. Described below is a case of life‐threatening thrombocytopenia induced by ibuprofen.
CONGENITAL ABSENCE OF THE GALLBLADDER: WAYS OF AVOIDING LAPAROTOMY
Authors: Akoh JA , George MM , Auld CD , Walls ADF
Published: April 2023

SUMMARY Two cases of congenital absence (agenesis) of the gallbladder seen at one hospital over a 5‐year period are presented. One patient presented with ascending cholangitis due to choledocholithiasis, while the other presented with right upper quadrant abdominal pain and equivocal findings on ultrasound and oral cholecystography. Although diagnosis was made at laparotomy in both cases, it is likely that the arrival of laparoscopic cholecystectomy will avoid laparotomy in the future. The place of laparoscopy in establishing the presence of this anomaly is discussed.
ACQUIRED PHARYNGEAL DIVERTICULUM FOLLOWING ANTERIOR CERVICAL FUSION OPERATION
Authors: Salam MA , Cable HR
Published: April 2023

SUMMARY We report an unusual case of a pharyngeal diverticulum arising as a result of extrusion of a bone graft inserted during anterior cervical fusion operation. The dense scar tissue at the site of extrusion of the bone graft probably caused traction on the posterior pharyngeal wall, with the development of a pharyngeal pouch. This is believed to be the first case with acquired pharyngeal diverticulum following anterior cervical fusion to be recorded in the literature.
THE ROLE OF LEVOCABASTINE IN THE TREATMENT OF ALLERGIC RHINOCONJUNCTIVITIS
Authors: Knight A
Published: April 2023

SUMMARY Allergic rhinoconjunctivitis is a common atopic condition frequently encountered in clinical practice, with prevalence figures as high as 20% reported. The socioeconomic impact of this condition is considerable — not only in terms of medical costs but lost work and schooldays and quality of life. A wide range of therapeutic approaches is available, including levocabastine, an extremely potent and highly specific H1‐receptor antagonist which has been developed for topical application as eyedrops and nasal spray. The available clinical data demonstrate that this agent is well tolerated, with an adverse effect profile comparable to sodium cromoglycate and placebo. Onset of action is rapid, with maximum therapeutic effects typically being observed within minutes of application. Results of comparative clinical trials suggest that topical levocabastine is as at least as effective as oral antihistamines and sodium cromoglycate for the treatment of allergic rhinoconjunctivitis, and it is suggested as an attractive alternative to oral antihistamines as first‐line therapeutic option.
OLSALAZINE IN COLLAGENOUS COLITIS
Authors: Alberti‐Flor JJ , Howell S
Published: April 2023

SUMMARY A case is reported of collagenous colitis treated successfully with olsalazine.
RENAL DISEASE ASSOCIATED WITH ANTINEUTROPHIL CYTOPLASMIC ANTIBODY: 39 PATIENTS OVER A 5‐YEAR PERIOD
Authors: Jeffrey RF , Khan AA , Davison A , Aparicio S , Gooi HC , Will EJ , Davison AM
Published: April 2023

SUMMARY We have reviewed 39 adult patients who presented over a 5‐year period with biopsy confirmed renal disease in association with positive antineutrophil cytoplasmic antibody (18 with C‐ANCA, 21 with P‐ANCA). Twenty‐three (59%) had primary systemic vasculitis, typically with aggressive renal histology including focal necrotising and crescentic glomerulonephritis. In the remaining patients a wide range of clinical syndromes and renal histological appearances were apparent: 30 had abnormal renal function (serum creatinine >140 μmol/l), including 17 who were initially dialysis‐dependent. Intensive immunosuppression was administered in 33 cases. When response was assessed at 3 months, renal function was stable or improved in 17 (52%), 5 of whom were able to discontinue dialysis. There was, however, an appreciable early mortality and, at latest follow‐up (1–57 months), 12 patients had died and 8 were on the dialysis programme. On immunosuppression, ANCA became negative in the majority (median time 1.5 months) but recurred during clinical relapse in 11 cases. In asymptomatic patients (12 cases), the reappearance of ANCA positivity did not herald clinical relapse. The ANCA assay has increased awareness of systemic vasculitis but not removed the need for histological confirmation before instituting immunosuppression.
CHLAMYDIAL INFECTIONS
Authors: Blanchard TJ , Mabey DCW
Published: April 2023

SUMMARY Chlamydiae are among the most successful bacterial pathogens, and there are few branches of medicine on which chlamydial infection and its sequelae do not impinge. Chlamydia trachomatis is responsible for many million cases of blindness, pelvic inflammatory disease, urethritis, epididymitis, infertility and ectopic pregnancy annually; it also causes lymphogranuloma venereum, reactive arthritis, ophthalmia neonatorum and infantile pneumonia. C. pneumoniae is among the most common causes of community‐acquired pneumonia, and recent evidence suggests that it may play a part in the pathogenesis of coronary heart disease. C. psittaci is a highly prevalent zoonotic infection with a wide host range. It is of great economic importance, and causes sporadic but sometimes devastating disease in humans. Most chlamydial infections are subclinical, but even if the initial illness is mild there may be serious long‐term sequelae. It is therefore important to identify and treat chlamydial infections in their early stages, but diagnosis usually depends on laboratory tests. Recent trials have shown that single doses of the long‐acting macrolide azithromycin are effective in the treatment of genital and ocular C. trachomatis infection, but longer courses of antimicrobials remain the mainstay of treatment for C. pneumoniae and C. psittaci infections.
ACUTE MYOCARDIAL INFARCTION: A RARE COMPLICATION OF THE THROMBOTIC TENDENCY IN NEPHROTIC SYNDROME
Authors: Lip GYH , Tean KN , Dunn FG
Published: April 2023

SUMMARY The association of nephrotic syndrome with a hypercoagulable state and vascular thrombosis is well recognised. We present a case of acute anterior myocardial infarction in a young man with nephrotic syndrome secondary to minimal change glomerulonephritis, in which subsequent coronary angiography showed no evidence of atherosclerotic coronary artery disease and thrombotic occlusion of an otherwise normal left anterior descending coronary artery was the likely cause of presentation.
PSEUDOHYPERPHOSPHATAEMIA AND MONOCLONAL GAMMOPATHY
Authors: Larner AJ
Published: April 2023

SUMMARY A case is reported of pseudohyperphosphataemia in association with a monoclonal gammopathy of undetermined significance.
SELECTIVE IgA DEFICIENCY PRESENTING WITH HYPERSPLENISM
Authors: Teh A , Bosco JJ
Published: April 2023

SUMMARY A young patient presenting with splenomegaly and hypersplenism was inadvertently found to have selective IgA deficiency. There were no symptoms of immunodeficiency and the patient responded well to splenectomy, with return of blood counts to normal without adverse effects. No other cause for the hypersplenism was found. We postulate selective IgA deficiency as a cause of splenomegaly and hypersplenism.
LINGUAL INFARCTION IN CRANIAL ARTERITIS
Authors: Mcrorie ER , Chalmers J , Campbell IW
Published: April 2023

SUMMARY An unusual case is described of infarction of the tongue as a presentation of cranial arteritis. The lingual necrosis may have been precipitated in part by the use of ergotamine to relieve the headache of the temporal arteritis, mistaken initially for migraine. The patient recovered with high‐dose steroid therapy.
STRUCTURAL CHANGES IN HYPERTENSION, THE POTENTIAL FOR THEIR PREVENTION, ARREST AND REVERSAL: A FOCUS ON FELODIPINE
Authors: Purcell H , Coats A
Published: April 2023

SUMMARY Hypertension is accompanied by a series of structural adaptations and pathological alterations in the heart and vessels. These include hypertrophy of the left ventricle and walls of resistance vessels, degeneration of elastic components in the walls of large arteries, atherosclerosis and glomerulosclerosis. In order to improve prognosis it is important that the antihypertensive drugs used can prevent or regress these processes, and this review focuses on the experience with the vascular selective calcium antagonist felodipine. Clinical studies show that antihypertensive treatment with felodipine promotes regression of left ventricular hypertrophy, increases compliance of large arteries, and has favourable effects on renal function. In addition, experimental data have shown that felodipine inhibits atherosclerotic plaque development. As structural cardiovascular changes appear early in hypertension, intervention with antihypertensive therapy is better initiated sooner than later. Vascular selective calcium antagonists, such as felodipine, appear effective in reducing blood pressure and in ameliorating hypertension‐induced structural changes.
THE USE OF BISPHOSPHONATES IN OSTEOPOROSIS
Authors: Fleisch H
Published: April 2023

SUMMARY Bisphosphonates comprise a relatively new class of drug developed to inhibit bone resorption. They are used in Paget's disease and tumour bone disease and recently also in osteoporosis. In the latter, they inhibit further bone loss in postmenopausal osteoporosis as well as other types of bone loss, such as that suffered during immobilisation or steroid therapy.
IT'S NOT CRICKET! MYOCARDIAL INFARCTION FOLLOWING NON‐PENETRATING BLUNT CHEST TRAUMA
Authors: Heymann TD , Cullinc W
Published: April 2023

SUMMARY While playing a game of cricket, a 42‐year‐old man was struck on the chest by the ball. The blunt trauma precipitated a myocardial infarct in the absence of other risk factors or evidence of pre‐existing coronary artery disease. Probable pathophysiological mechanisms and potential problems of immediate treatment are discussed.
VESTIBULOCOCHLEAR DYSFUNCTION FOLLOWING EPIDURAL ANAESTHESIA IN LABOUR
Authors: Martin‐Hirsch DP , Martin‐Hirsch PL
Published: April 2023

SUMMARY A case is reported of vestibulocochlear dysfunction following accidental dural tap during epidural anaesthesia in labour. The aetiology and the world literature are reviewed.
SCREENING AND TREATMENT FOR HYPERUPIDAEMIA IN NON‐INSULIN‐DEPENDENT DIABETES: A PROSPECTIVE ASSESSMENT OF 350 PATIENTS
Authors: Smellie WSA , Sandler D , O'Donnell J , Maccuish AC
Published: April 2023

SUMMARY This report presents experiences in screening 350 non‐insulin‐dependent diabetics for hypercholesterolemia and results of 1 year's treatment. Mean serum total cholesterol was 6.4 mmol/l at screening; 46 patients whose initial total serum cholesterol was above 7.0 mmol/l attended for detailed assessment and treatment. Mean total cholesterol concentrations fell between screening and review (7.8 vs 7.1 mmol/l, P<0.01). Levels fell below 7.0 mmol/l in 13 patients with diet alone. After excluding patients with secondary dyslipidaemia (including poor diabetic control), 10 patients received lipid‐lowering drug treatment. Total cholesterol and triglyceride concentrations fell significantly and the HDL/non‐ HDL cholesterol ratio improved on treatment. Screening diabetic patients identifies a small group of hyperlipidaemic patients, whose lipoprotein profiles improve with drug treatment. Many of those screened, however, do not ultimately require drug treatment using a cut‐off of 7.0 mmol/l.
DUAL‐ENERGY X‐RAY ABSORPTIOMETRY IN RHEUMATOID ARTHRITIS: COMPARISON BETWEEN AXIAL AND APPENDICULAR SKELETON FINDINGS
Authors: Andonopoulos AP , Yarmenitis SD , Dimopoulos PA
Published: April 2023

SUMMARY Bone mineral density was measured by dual‐energy x‐ray absorptiometry (DXA) at the lumbar spine, both hips and distal radius in 10 postmenopausal patients with rheumatoid arthritis (RA). DXA values at the lumbar spine and distal radius were compatible with osteoporosis in all but 1 patient. Only 4 patients had osteoporosis of the hip, and 3 of these were over 65. Preliminary results over this small population suggest that in RA a correlation may be expected between DXA values in lumbar spine and distal radius, but not between either of these and the hip.
INDIVIDUALISATION OF HIV THERAPY: THE CLINICIAN'S PERSPECTIVE
Authors: Gazzard BG , Moyle GJ
Published: April 2023

SUMMARYAssessment of clinical and laboratory markers of HIV infection may be used to individualise antiretroviral therapy. Data suggest that measures of viral load may be of considerable value as both a baseline and dynamic therapy marker, making these tools particularly useful in driving therapeutic decisions. Similarly, in‐vitro data regarding intracellular pharmacokinetics and activity, resistance patterns and potential synergy of antiretroviral agents may be used to guide selection of optimal treatment regimens in clinical practice.
VOLVULUS OF THE STOMACH ASSOCIATED WITH COLON IN THE CHEST
Authors: Chinegwundoh FI , Kirkham JS
Published: April 2023

SUMMARY Two cases of intrathoracic hernia of colon and stomach complicated by gastric volvulus are reported.
TRANSECTION OF THE PANCREATIC HEAD FOLLOWING BLUNT ABDOMINAL TRAUMA
Authors: Kealey WDC , Garstin WIH , Diamond T
Published: April 2023

SUMMARY Pancreatic trauma is rare, with a reported incidence of 0.4 per 100 000. Transection of the pancreas is extremely rare and usually involves the body region. An unusual case of pancreatic trauma, with complete transection through the pancreatic head, is described.
PARTIAL HYPOPITUITARISM IN KLINEFELTER'S SYNDROME
Authors: Hughes TAT , Borsey DQ
Published: April 2023

SUMMARY A patient with Klinefelter's syndrome, secondary hypothyroidism and absent growth hormone and prolactin reserves is described. This combination of pituitary hormone deficiency has not been reported previously in association with Klinefelter's syndrome.
A COMPARISON OF PRESCRIBED MEDICATION IN LEARNING DISABILITY PATIENTS BEFORE AND AFTER RESETTLEMENT FROM HOSPITAL INTO THE COMMUNITY
Authors: Obaydi H , Eva FJ , Puri BK
Published: April 2023

SUMMARY The use of prescribed medication was examined in 34 people with learning disability who underwent a planned resettlement from a hospital into the community. No significant differences were found in the number of subjects receiving antipsychotic, antimuscarinic, antidepressant, and anticonvulsant medication, lithium preparations, and non‐psychoactive medication, just prior to discharge and 1 year after discharge. This study indicates that long‐stay hospitalised adults with moderate, severe or profound mental retardation can successfully be relocated into the community — in spite of suffering from behavioural and major psychiatric disorders — with the aid of appropriate medication, psychiatric follow‐up, and community resources.
ACUTE APPENDICITIS PRESENTING WITH SURGICAL EMPHYSEMA AND PNEUMOMEDIASTINUM
Authors: McCahy P , Talbot D , Rawlinson J , Higgs MJ
Published: April 2023

SUMMARY A case is reported of a young man presenting with abdominal pain and surgical emphysema of the neck. A chest x‐ray revealed pneumomediastinum but other investigations excluded oesophageal rupture. He was found to have a complicated acute appendicitis. The history and likely causes of this unusual presentation of a common complaint are reviewed.
MEDIAN NERVE ENTRAPMENT AFTER ELBOW DISLOCATION: A NEW RADIOLOGICAL SIGN
Authors: Packer GJ , Lennox CME
Published: April 2023

SUMMARY A case is reported of median nerve entrapment as a rare complication of posterior dislocation of the elbow.
SALMONELLOSIS COMPLICATED BY MYOCARDIAL ABSCESS AND CEREBRAL MYCOTIC ANEURYSMS
Authors: Sproule MW , Briggs MJE
Published: April 2023

SUMMARY In a 69‐year‐old man with recurrent rigors after an episode of diarrhoea due to Salmonella enteritidis, investigation failed to reveal the presumed abscess. He died 5 weeks after initial presentation despite appropriate antibiotic therapy. Postmortem examination revealed ruptured cerebral mycotic aneurysms as the cause of death; a myocardial abscess was found at the site of an infarct scar.
ONSET OF ACTION OF EFORMOTEROL BY DRY POWDER INHALER: OBJECTIVE AND SUBJECTIVE MEASURES
Authors: Maesen FPV , Smeets SJ , Costongs MAL , Zweers PGMA , Pfeil JPJ
Published: April 2023

SUMMARY This double‐blind, randomised, placebo‐controlled crossover trial in 18 adults with asthma evaluated the onset of efficacy of doses of 12 and 24μg eformoterol delivered as a dry powder, and compared patients' subjective assessments of efficacy with objective measures. Bronchodilatory efficacy was measured in terms of specific conductance (sGaw) and forced expiratory volume in one minute (FEV1). With both doses of eformoterol, a bronchodilatory effect was observed one minute after inhalation. The difference in bronchodilator effect (sGaw and FEV1) between both eformoterol doses and placebo was statistically significant (p<0.01) from one minute onwards. No significant difference in onset of action or peak effect was seen between the two doses of eformoterol. Patients' subjective reports were closely related to the observed onset of efficacy and indicated no difference between the two eformoterol doses.
PYODERMA GANGRENOSUM: AN UNUSUAL CAUSE OF PERIAURAL ULCERATION
Authors: Oluwole M
Published: April 2023

SUMMARY A case of pyoderma gangrenosum affecting the pinna and neck of a diabetic patient is reported. Appearances were suggestive of malignant otitis externa. A small biopsy resulted in rapid and aggressive exacerbation of the lesion. Pyoderma gangrenosum, although uncommon, should be considered as a cause of ulceration, particularly when the ulcer yields no growth on culture in a non‐dependent area.
EMPHYSEMATOUS CYSTITIS IN AN ELDERLY PATIENT
Authors: Jack CIA , Robinson R , Lye M
Published: April 2023

SUMMARY A case of emphysematous cystitis in an elderly woman with well controlled non‐insulin dependent diabetes mellitus is presented.
EFFICACY OF TWICE‐DAILY AMOXYCILLIN/CLAVULANATE (‘AUGMENTIN‐DUO’ 400/57) IN MILD TO MODERATE LOWER RESPIRATORY TRACT INFECTION IN CHILDREN
Authors: Cook RC , Zachariah J , Cree F , Harrison HE
Published: April 2023

SUMMARY A new amoxycillin/clavulanate regimen (‘Augmentin‐Duo’ 400/57), to be given orally in two divided doses, has been proposed to overcome the inconvenience of tid dosing. This observer‐blind, multicentre study randomised children aged two to 12 years with lower respiratory tract infection to seven days' treatment with either amoxycillin/clavulanate bid at a dose of 25/3.6mg/kg/day (221 patients) or the currently prescribed amoxycillin/clavulanate regimen of 20/5mg/kg/day tid (216 patients). Clinical success (cure) rates at follow up were 81.0% for the bid group and 77.8% for the tid group [difference 3.2%; 95% CI (‐4.36, 10.80)], indicating that the regimens were of equivalent efficacy. Both regimens were well tolerated, and there was no statistically significant difference in the incidence of adverse experiences between the two groups. Compliance with study medication was high and similar for both groups (80% compliance: bid 90.0%; tid 87.0%).