bluuebunny/crossref_metadata_2025 huggingface dataset:
Kinetics of lead interaction with human erythrocytes
Authors: Barltrop D , Smith A M
Published: December 2008

The kinetics of the interaction of lead with human erythrocytes has been investigated in vitro by means of tracer studies with 203Pb. The elution characteristics of lead from erythrocytes in contact with EDTA suggest the existence of two binding sites differing in their affinity for lead. The findings are consistent with the existence of two compartments for lead binding in the cell, and a model system based on this concept is proposed.
Absorption of lead from dust and soil
Authors: Barltrop D , Thornton I , Strehlow C D , Webb J S
Published: December 2008

The lead burdens for children and mothers exposed to lead-contaminated soils and dusts have been investigated in a rural district with minimal atmospheric pollution. A significant relationship was observed between the lead content of blood and hair of children exposed to soils of mean lead content in the range 420-13,969 p.p.m. The blood lead concentration of children was consistently greater than that of their mothers. No consistent relationship was found between blood lead values and pica for soil. In this situation, lead in soil provided a small additional burden for children but in itself was insufficient to constitute a hazard.
The function of sleep
Authors: Oswald Ian
Published: December 2008

Evidence is reviewed that points to sleep as a time during which synthetic processes for growth and repair are enhanced. REM (paradoxical) sleep seems especially related to increased synthetic processes in the brain.
Sleep deprivation treatment in depression: a review
Authors: Roy A , Bhanji S
Published: December 2008

Ten studies, including the authors' own, suggest that sleep deprivation may be a useful treatment in a third to a half of patients with endogenous depression. Caution and a controlled trial are suggested.
Myocarditis complicating cytomegalovirus mononucleosis
Authors: Ball S G , Archer G J
Published: December 2008

A case of cytomegalovirus mononucleosis with myocarditis as the major presenting clinical manifestation is described. The rarity of symptomatic myocarditis in this condition is discussed.
Smell as a diagnostic marker
Authors: Liddell K
Published: December 2008

The odour emitted by the patient may be one of the first major clues leading to an early diagnosis. Certain dermatological conditions produce an obnoxious smell and several metabolic diseases are associated with a characteristic odour. Schizophrenia and several rare inborn errors of metabolism associated with enzyme deficiencies are linked with distinctive body odour.
Sputum and mucociliary clearance mechanisms
Authors: Reid Lynne
Published: December 2008

Bronchial secretion forms a periciliary liquid layer and may also give rise to thicker secretion that moves on the tips of the cilia. This latter material as collected at bronchoscopy or coughed up as sputum is a viscoelastic substance behaving in a characteristic way over a wide range of shear rates. The anatomical basis of secretion is described and its control as established by organ culture.
A case of fat embolism following Shiers' arthroplasty
Authors: Browne C H
Published: December 2008

A case of fatal fat embolism following Shiers' replacement arthroplasty of the knee is reported and some of the mechanisms involved discussed.
Further experience with discriminant functions in differential diagnosis of hypercalcaemia
Authors: Fraser Patricia , Healy Michael , Watson Lyal
Published: December 2008

Further experience has been obtained in the use of discriminant functions in the differential diagnosis of hypercalcaemia from the study of 140 new patients. The discriminant functions described in an earlier paper were derived from the results for plasma inorganic phosphate, alkaline phosphatase, chloride, bicarbonate and urea obtained from hypercalcaemic patients on admission to hospital. They indicated the correct diagnosis in ninety-two of 103 new hypercalcaemic patients (89·3%) admitted to University College Hospital and in thirty-one of thirty-seven hypercalcaemic patients at two other hospitals.

Revised discriminant functions have been calculated including the erythrocyte sedimentation rate as a sixth variable. These revised functions have led to some improvement in diagnostic accuracy. The correct diagnosis was indicated in ninety-three of ninety-eight patients (94·9%) at University College Hospital and in thirty-three of the thirty-seven patients at the two other hospitals.
Oats and barley toxicity in coeliac patients
Authors: Baker P G , Read A E
Published: December 2008

The effect of addition of oats and barley to the glutenfree diets of a group of patients with coeliac disease has been studied using the oral 5 g xylose excretion test to assess small bowel function before and after these supplementations.

Both oats and barley were found to be potentially harmful to coeliac patients although the toxic effect of barley was more readily produced than that of oats.

On the basis of their results, the authors recommend the exclusion of both barley and oats, in addition to wheat and rye, from the coeliac diet. In view of the well recognized risk of the development of malignancy, such a diet should be followed particularly rigorously in those patients with a persistence of symptoms and of marked villous atrophy.
Left lobe amoebic liver abscess
Authors: Rasaretnam Rudra , Wijetilaka Shelton E
Published: December 2008

For reasons which are not quite clear amoebic liver abscesses in the left lobe are relatively uncommon. On account of the lesser bulk of the left lobe, and the potentially greater space under the left hemidiaphragm, expansive lesions within it remain less obtrusive than corresponding lesions in the right. Sixteen such cases are analysed and five distinct modes of clinical presentation have been found. Eight of the patients presented late with perforation into either the peritoneal or pleural cavities. In seven of eight remaining cases, an abdominal mass suggestive of a left lobe lesion was present. Anaemia, leucocytosis and a raised erythrocyte sedimentation rate were usually present, and in the five cases seen in the last year a positive reaction was obtained to the indirect fluorescent antibody test. Confirmatory radiological features were present only in advanced cases.
Exophthalmos in the Guillain-Barré syndrome. An unusual presentation
Authors: Boddie Grahame , Sambrook Michael A , Mohr Peter D
Published: December 2008

Papilloedema, multiple cranial nerve palsies, and autonomic nervous system dysfunction have become increasingly well recognized as occurring in the Guillain-Barré syndrome. Such a patient was recently encountered in whom the additional presenting feature of severe bilateral exophthalmos led to delay in reaching the correct diagnosis. Because of this delay and ensuing respiratory complications, permanent visual failure secondary to papilloedema occurred.
Use of temperature-sensitive mutants of influenza A virus as live virus vaccine strains. Evaluation in laboratory animals, adults and children
Authors: Murphy Brian R , Richman Douglas D , Spring Susan B , Chanock Robert M
Published: December 2008

Temperature-sensitive (ts) recombinants of influenza A virus were evaluated for use in a live virus vaccine. Evidence from several sources suggested that the ts lesions were responsible for attenuation of these mutants. Specification of attenuation by defined genetic lesions which can be assayed for in the laboratory offers an advantage to the use of ts viruses for vaccination. This means that ts recombinants can be assessed for genetic stability during vaccine development, production and later during usage in man. One ts virus, influenza A/Hong Kong/68-ts-1[E], with a 38°C shut-off temperature, had the following properties desirable for a live virus vaccine: (1) satisfactory infectivity for seronegative (serum HI antibody titre ≤ 1:8) adults; (2) satisfactory attenuation for adults; (3) capacity to stimulate local and serum anti-haemagglutinin and anti-neuraminidase antibodies in seronegative volunteers; (4) stimulation of resistance to virulent, wild type virus; (5) relative genetic stability in vivo; (6) lack of communicability in man; (7) replication to high titre in avian leucosis virus-free eggs; and (8) localization of ts lesions to genes that do not code for the haemagglutinin and neuraminidase. The ts lesions of influenza A/Hong Kong/68-ts-1[E] virus were transferred to more current viruses within the H3N2 subtype (influenza A/Udorn/307/72 and influenza A/Georgia/101/74). These recombinant Udorn/72 and Georgia/74 ts viruses, which possessed the same shut-off temperature and the same ts lesions as the influenza A/Hong Kong/68-ts-1[E] parent virus, exhibited a pattern of infection and attenuation in hamsters and man similar to their ts parent. These data suggest that ts mutants which are sufficiently attenuated for man, could serve as donors of ts lesions for the rapid production of an attenuated vaccine when new antigenic variants arise.

When the influenza A/Hong Kong/68-ts-1[E] virus was administered to children who lacked both anti-haemagglutinin and anti-neuraminidase antibody the virus replicated for a longer period than in adults and mild fever developed in some of the young vaccinees. A minority of children shed wild type revertant virus. The emergence of wild type virus in children, but not in adults, probably reflected the more extensive replication of the virus in the doubly seronegative children. The implications of these findings to the development and testing of live influenza A virus vaccines were discussed.
The production of live attenuated influenza A strains by recombination with A/Okuda/57 (H2N2)
Authors: McCahon D , Beare A S , Stealey V
Published: December 2008

A new recombination system for the production of live attenuated influenza-A vaccine strains is described. The attenuated parent is the Japanese strain A/Okuda/57 (H2N2) which has a known passage history and a good record of human safety. This virus has been recombined with two recent field isolates, A/England/42/72 and A/Finland/4/74, and in each case several recombinants were isolated and tested in volunteers. These recombinants differed in their degree of attenuation, but on each occasion it was possible to choose one that was suitably attenuated for a candidate vaccine strain. The genetic stability of such a recombinant produced with the A/England/42/72 strain was demonstrated by subjecting it to three successive human passages. A single intra-nasal dose of the A/Finland/4/74 recombinant vaccine gave a seroconversion rate of 75%.

This recombination system offers considerable advantages for the production of live influenza virus vaccines.
Detection of high coronary risk
Authors: Rose Geoffrey
Published: December 2008

Signs of early myocardial ischaemia are the most powerful available predictors of myocardial infarction and CHD death. The main primary risk factors are of undiminished importance in such persons, but screening for myocardial ischaemia is not recommended without evidence that intervention at this late stage is effective.

Estimates are presented of the relative importance to individuals of the main primary risk factors. Their importance as population risk factors is different, depending on the product of attributable risk and prevalence: a high risk with low prevalence, as from severe hypercholesterolaemia, is of small importance compared with that arising from the numerous individuals with smaller elevations. Most cases of CHD arise from the common and therefore inconspicuous combination of slight increases in two or three factors in the same individual. Selective and opportunistic risk factor screening is recommended, not a general service.

An extension of clinical responsibility in the direction of preventive responsibility is generally accepted as proper, even though it is slow in being applied. When someone with symptomless hypertension is given hypotensive drugs with the object of reducing the risk of stroke, that is preventive medicine. The subject having made no complaint is not strictly a patient: but the clinician accepts a responsibility for him because of the high risk that he will become a patient if nothing is done. This is an analogy for our concern with identifying subjects with a high coronary risk, and the attempt in such persons to prevent the onset of major ischaemia.
Primary and secondary prevention trials in coronary heart disease
Authors: Shaper A G
Published: December 2008

Trials in primary and secondary prevention of coronary heart disease (CHD) are reviewed. The results of completed primary prevention trials suggest that dietary changes in middle-aged men may lower the incidence of CHD. Multifactorial trials may achieve an even greater reduction in CHD. Secondary prevention trials indicate that stopping smoking and the use of beta-blocking agents are effective in reducing recurrence rates.
Agranulocytosis and systemic candidiasis following clomipramine therapy
Authors: Souhami R L , Ashton C R , Lee-Potter J P
Published: December 2008

A case of agranulocytosis following clomipramine treatment is described. The period of agranulocytosis lasted for 19 days and was complicated by systemic Candida infection which was successfully treated with flucytosine.
An eighteen months' study of the clinical response to metoprolol, a selective α1-receptor blocking agent, in patients with angina pectoris
Authors: Comerford M B , Besterman E M M
Published: December 2008

Following an initial dose response study, metoprolol, a selective beta1-receptor blocking agent, was compared with equipotent dosages of propanolol in a double blind cross-over study, including exercise tolerance tests, on fourteen patients with angina pectoris. Long term therapy with metoprolol then followed until the seventy-second week. Patients performed 8% more total work on metoprolol with 15% more work recorded up to the onset of S-T depression, in comparison with propranolol. In the long term, ther was no significant difference in work performed when the daily dosage of metoprolol was changed from a q.i.d. to a b.d. regime. Metoprolol was shown to be an effective anti-anginal compound with good tolerance and safety, with gradual improvement in underlying myocardial ischaemia during long term treatment.
Pregnancy following poliomyelitis
Authors: Daw E , Chandler G
Published: December 2008

A review of forty-nine pregnancies in thirty-seven patients who had previously suffered from poliomyelitis found that obstetric complications were proportional to the clinical disabilities of the patient. A simple test of unilateral weight-bearing gives a good clue as to whether pelvic asymmetry is present.
The use of plastic isolators to prevent infection in neutropenic patients
Authors: Goldman J M , Spiers A S D , Trexler P C , Gaya H , Gordon A M
Published: December 2008

Over the last 5 years plastic isolators have been used for the prevention of infection in patients with severe neutropenia. Fifteen patients in differing stages of acute myeloid and chronic granulocytic leukaemia were managed in isolators for a total of 110 patient-weeks. The mean duration of isolation for each patient was 7·4 weeks with a range of 2-14 weeks. There was no evidence that any of the isolated patients acquired infection with any exogenous micro-organism. The psychological problems of isolation proved less onerous for the patients than had been anticipated by the medical and nursing staff and no patient had to be removed from isolation for psychiatric reasons. Unfortunately the reduced incidence of clinical infection in the isolated patients was not obviously associated with an increase in effectiveness of their anti-leukaemic treatment.
Protection of Health Service staff
Authors: Lunn J A
Published: December 2008

The practical problems involved in immunizing hospital staff are discussed as well as some of the changing priorities for protection as a result of a changing incidence of infectious disease. Some skin problems are mentioned with a view to improving protection for staff at risk. The cost and value of routine stool testing of catering workers is discussed, and the question raised as to whether money saved from these tests might be better spent on improving kitchen hygiene and working facilities.
Phaeochromocytoma with myocarditis managed with alpha-methyl-p-tyrosine
Authors: Begnall W E , Salway J G , Jackson E W
Published: December 2008

A case of bilateral phaeochromocytoma with catecholamine-induced myocarditis is described. The two operations needed allowed comparison of the use of alpha-methyl-p-tyrosine alone and in conjunction with adrenergic blocks in the management of the patient. The combination of both drugs was particularly successful in the relief of symptoms and reduction of catecholamine metabolism as monitored by 4-hydroxy-3-methoxymandelic acid (HMMA) excretion. As myocarditis is a potentially fatal complication, further investigation of the combined use of alpha-methyl-p-tyrosine and adrenergic blocking drugs is suggested in the pre-operative management of patients with phaeochromocytoma.
Observations on the treatment of dissection of the aorta
Authors: Thenabadu P N , Steiner R E , Cleland W P , Goodwin J F
Published: December 2008

The results are presented of treatment in twenty-three patients with dissection of the thoracic aorta, in four of whom it was acute (less than 14 days' duration), and in nineteen chronic (more than 14 days' duration). Sixteen patients had Type I and II dissection (involving the ascending aorta) and five Type III (descending aorta at or distal to the origin of the left subclavian artery); in two, dissection complicated coarctation of the aorta in the usual site. Thirteen patients had aortic regurgitation.

Three of the patients with acute dissection were treated medically; two, both with Type I dissection, died, and the third, with Type III, survived. The remaining acute patient was treated surgically and also died.

Of the patients with chronic dissection, eight were treated medically and eleven surgically. None of the medical group died in hospital; three died between 3 months and 1 year, and five have survived from periods of 12-72 months. Eleven patients with chronic dissection were treated surgically; four died in hospital at or shortly after operation; and the remaining seven lived for periods of 12-84 months.

The presentation, indications for surgical treatment and results are discussed. It is concluded that surgical treatment of chronic dissection may carry a higher initial mortality than medical, but that there may be slightly better overall long term results in the former. As this series was not selected randomly, because patients with complications were selected for surgery, and there are only a few patients in each group, the results do not permit firm conclusion regarding the relative merits of medical and surgical treatment.

It is suggested that all patients should initially be treated medically but that surgical treatment should be considered if the dissection continues, if aortic regurgitation is severe, if an aneurysm develops or enlarges, if cardiac tamponade develops or there is evidence of progressive involvement of the branches of the aorta. Attention is drawn to the important syndrome of chronic dissecting aneurysm of the ascending aorta with severe aortic regurgitation which requires definitive surgical treatment and aortic valve replacement. The importance of adequate visualization of the origin and extent of the dissection as a preliminary to surgical treatment is stressed.
Calculus disease of the urinary tract at a district hospital
Authors: Jeffery P J
Published: December 2008

At a District General Hospital the organization of a clinic for the investigation and treatment of patients with calculus disease of the urinary tract is described. The way in which such a clinic may be orgainzed is discussed and the results presented. In patients with idiopathic hypercalciuria, sodium cellulose phosphate causes a significant reduction in urinary calcium levels when used in such a clinic.
Hereditary nephritis (with unusual renal histology): report of a first case from the West Indies
Authors: Hayes J S , Jankey N
Published: December 2008

A 21-year-old Grenadian girl undergoing investigation in Trinidad for anaemia was diagnosed as a case of hereditary nephritis. She had the clinical features of a nephropathy, nerve deafness and an ocular defect. Renal histology was exceptional in that in addition to the typical findings of a hereditary nephritis, cystic areas generally associated with medullary cystic disease were noted. Several members of the patient's maternal family were afflicted with either deafness visual distrubances or renal disease.
Medical versus surgical treatment of stable angina pectoris: progress report of a large scale study
Authors: Hultgren Herbert N , Takaro Timothy , Detre Katherine
Published: December 2008

A large scale, prospective, randomized study of surgical v. medical management of disabling angina pectoris is being conducted as a cooperative study among thirteen Veterans Administration hospitals in the U.S.A. A total of 1015 patients have been entered into the study and follow-up data are currently being evaluated. Patient entry into the study was concluded in December 1974. Patient compliance has been acceptable with only 7% of patients not adhering to their randomization category. Thirty-day operative mortality (1972-1974) in 309 patients was 5-3%. The patient population exhibited a severe degree of coronary disease. There was ECG evidence of prior myocardial infarction in 40%. There were significant obstructive lesions in three major coronary arteries in 51% and significant lesions of the left main coronary artery in 11%. Medical and surgical treatment groups demonstrated no significant differences in objective descriptive characteristics. Mortality in the medical group at 1 year was 8%. Mortality was influenced by several factors including the number of vessels involved, left ventricular function and the presence of left main coronary artery disease. The lowest mortality occurred in patients with single vessel disease and normal LV function who had a 1-year mortality of 3%. Patients with 3-vessel disease and abnormal LV function exhibited a 14% 1-year mortality. Patients with disease of the left main coronary artery and poor LV function had a 1-year mortality of 37%. Analyses of the results of treatment modalities in sub-groups is currently being performed and will be reported in future publications.
Indications, technique and results of caudal epidural injection for lumbar disc retropulsion
Authors: Sharma P K
Published: December 2008

The indications, contra-indications and technique of caudal epidural injections in the treatment of low back pain and sciatica are described. Of 201 patients treated by epidural injection, about 56% had favourable results.
Congestive cardiomyopathy in a family of Becker's X-linked muscular dystrophy
Authors: Katiyar B C , Misra S , Somani P N , Chaterji A M
Published: December 2008

Ths dissociation of gross congestive cardiomyopathy and muscle disease in different members of a family affected with Becker's benign X-linked muscular dystrophy is described. The possibility that cardiomyopathy and muscular dystrophy may be the expressions of the same mutant gene has been suggested.
An investigation of renal function in chronic bronchitis
Authors: Daggett P
Published: December 2008

An investigation has been made into various parameters of renal function in patients with chronic bronchitis and in a group of hypoxic controls. Abnormalities of glomerular filtration rate and of water handling have been demostrated in chronic bronchitic patients but not in hypoxic controls. The abnormalities are related to the arterial Pco2. A hypothesis is presented as to the role of CO2 in causing abnormalities of renal function in chronic bronchitis.
Simple techniques to treat medical phobias
Authors: Taylor C B , Ferguson J M , Wermuth B M
Published: December 2008

Participant modelling, a behaviourally-orientated treatment technique, is an effect method of treating phobias associated with minor medical procedures or apparatus such as needles or intravenous catheters. The steps in this technique are described and two cases of severe needle phobias successfully treated with participant modelling are presented to illustrate further its application.
Sarcoma complicating therapy with cyclophosphamide
Authors: Marks J S , Scholtz C L
Published: December 2008

A patient is described who developed a poorly differentiated sarcoma after cyclophosphamide was used to treat his rheumatoid arthritis. This case emphasizes the importance ot considering neoplastic disease as a potential hazard associated with the use of immunosuppressive drugs.
Histiocytic medullary reticulosis with hypogammaglobulinaemia and disseminated intravascular coagulation
Authors: Clarke P D , Amos R S , Edwards C W , Geddes A M
Published: December 2008

A case of histiocytic medullary reticulosis in a 45-year-old man is described. The presentation with a swinging pyrexia is typical. Associated features were very low levels of all immunoglobulins and proved disseminated intravascular coagulation. Heparin therapy was given and the difficulties of controlling such treatment are demonstrated. It is concluded that an increased awareness of the condition as a cause of pyrexia might lead to an improvement in prognosis.
Tricuspid incompetence complicating acute myocardial infarction
Authors: Collins R , Daly J J
Published: December 2008

A case of persistent tricuspid incompetence due to acute myocardial infarction is described. Review of the literature has revealed no similar case.
An approach to realistic evaluation of antihypertensive regimes
Authors: Carlisle R , Akinkugbe O O , Basile U , Solagbade M E
Published: December 2008

Where practicable, all subjects found with onset-phase-four blood pressure of 90 mmHg or more after referral were allocated, on a random basis, to alternative antihypertensive regimes at a dosage related to response. Of those 110 receiving either guanethidine, methyldopa or debrisoquine, only the group on methyldopa had significantly reduced median blood pressure by two out of four criteria and after 6 months of therapy. It is nevertheless considered that by assessment of the total group more significant conclusions can be drawn for an eventual attempt to control hypertension on a community basis than by studies of highly selected groups treated under unusually favourable conditions.
Practolol-induced autoantibodies and their relation to oculo-cutaneous complications
Authors: Jachuck S J , Stephenson J , Bird T , Jackson F S , Clark F
Published: December 2008

Tissue auto-antibodies were investigated in fifty-one patients (twenty-five female, twenty-six male) receiving practolol for ischaemic heart disease or dysrhythmias and compared with those found in 204 patients (fifty-eight female, 146 male) with ischaemic heart disease who did not receive practolol. Antinuclear factor (ANF) was found in 24% female and 16% male patients receiving practolol, but only in 5% of female and 4% of male patients who were not taking practolol. Thyroid cytoplasmic antibody (TCA) was detected in 16% female and 20% of male patients receiving practolol, compared to 10% of females and 6% of males in the control group. The incidence of ANF and TCA was significantly higher (P less than 0-05) in patients receiving practolol compared to the control group. The occurrence of gastric parietal cell antibody (PCA) and smooth muscle antibody (SMA) was not associated with practolol therapy (odds ratio of 2-4 and 1-9 respectively). The incidence of skin and eye complications was found to be 10% and the female to male ratio of this complication was 4 : 1. The correlation between autoantibody production and oculo-cutaneous complications could not be established in such a small group but three of the patients with the complications were found to have PCA, although PCA was found not to be associated with practolol therapy. Four of the five patients with the complications did not have circulating ANF.
Angiokeratoma corporis diffusum: the evolution of a disease entity
Authors: Taaffe A
Published: December 2008

The clinical features, diagnosis management, aetiology and inheritance of angiokeratoma corporis diffusum (Fabry's disease) are discussed and the literature reviewed. The treatment and knowledge generally of this rare condition have not greatly improved in 75 years.
A study of the effect of povidone-iodine on wound healing
Authors: Gilmore O J , Reid C , Strokon A
Published: December 2008

The effect of dry powder povidone-iodine (Disadine D.P.) on wound healing was assessed experimentally and clinically. It did not interfere with wound healing macroscopically, histologically or mechanically in Wistar rats. One hundred and one patients undergoing 'clean' elective surgery were included in the controlled clinical study and povidone-iodine did not affect wound healing in any way. In the control group 4% of patients developed infection compared with none of those sprayed with povidone-iodine. No adverse reaction to povidone-iodine was seen in either study. This antiseptic offers a safe alternative to antibiotics for use at operation whenever there is risk of wound infection from operative bacterial contamination.
Primary anorexia nervosa (weight phobia) in males
Authors: Hasan M K , Tibbetts R W
Published: December 2008

Ten cases of primary anorexia nervosa (weight phobia) in males (as against 196 females) have been treated in the United Birmingham Hospitals over 19 years. A discrete syndromes appears to exist with much to support the view that it is the counterpart of primary anorexia nervosa in the female. Six illustrative case histories are described briefly. The heavy loading with consistent abnormalities of psychiatric interest makes it very probable that weight phobia is primarily a psychiatric disorder.
Primary unruptured ovarian pregnancy with intrauterine device
Authors: Saber R S
Published: December 2008

A case of intrafollicular and unruptured ovarian pregnancy associated with intrauterine device which meets the rigid criteria of Spiegelberg (1878) is presented. Clinically, unruptured cases can be confused with ovarian cysts. Intrauterine devices are highly effective for protection against uterine gestation and to a lesser degree against tubal gestation, but they have no effect in preventing ovarian gestation.
Facial nerve injury. A short review
Authors: Potter J M
Published: December 2008

Despite considerable advances in technique, experience and skill, the precise place of surgery in the treatment of facial nerve injury remains uncertain. The mechanism of delayed facial palsy is not yet clear, and there is still debate about the value of tests for early evidence of denervation. Recent literature has been reviewed.
Malabsorption in relation to abdominal irradiation and quadruple chemotherapy for lymphosarcoma
Authors: Scarpello J H , Sladen G E
Published: December 2008

A case of severe diarrhoea and steatorrhoea following chemotherapy and abdominal irradiation for lymphosarcoma, is described. Investigations demonstrated bile acid malabsorption, and treatment with cholesytramine and a low fat diet was successful. A questionnaire was sent to thirty-two subjects who had undergone similar treatment for similar pathology and failed to demonstrate any sustained alteration of bowel function. Additionally, nine of these subjects underwent a 14C-glycocholic acid test and no evidence of interruption of the enterohepatic circulation of bile acids was found.
Pneumothorax and hydrothorax after subclavian vein cannulation
Authors: Holt S , Myersough E
Published: December 2008

A patient is described who developed a right pneumothorax and a left hydrothorax following percutaneous subclavian vein cannulation. The prevention, diagnosis and treatment of this complication are discussed.
Early prediction of the outcome of a paracetamol overdose based on an analysis of 163 patients
Authors: Gazzard B G , Widdop B , Davis M , Hughes R D , Goulding R , Williams R
Published: December 2008

Clinical and biochemical data obtained from 163 patients who had taken an overdose of paracetamol were examined to determine which factors or measurements were of value in predicting the severity of ensuing liver damage early after ingestion of tablets. Although the overall severity of hepatic necrosis was found to increase with the dose of paracetamol ingested, correlation was not sufficiently close to provide an accurate prognostic index in individuals. Severe hepatic damage was less likely if the patient had vomited or had a stomach wash-out within 6 hr of overdose. The plasma concentrations of paracetamol, measured at known times after overdose, distinguished those who developed hepatic dysfunction from those who did not, but there was a poor correlation, particularly in the first 6 hr after ingestion of tablets, between these values and the severity of ensuing liver damage. Estimates of early plasma paracetamol half-lives from three or more samples taken within 4 hr of admission showed that all patients developing moderate or severe liver damage had half-lives greater than 4 hr, but this was also the case in nearly one-third of those with minimal liver lesions only.

It is concluded that there is no completely reliable early prognostic test for individual patients with paracetamol overdose. If each patient is selected for treatment with cysteamine (mercaptamine) or other agents on the basis of plasma paracetamol levels, up to 30% may receive this agent who are at risk from trivial hepatic damage only.
Accidental ingestion of poisons and child personality
Authors: Sibert J R , Newcombe R G
Published: December 2008

The personality of 105 children under 5 years of age admitted to Cardiff Hospital was compared with 105 control children by means of a semantic differential test. Poisoning-children were significantly more anxious (P less than 0-008), harder (P less than 0-01), and more active (P less than 0-04) than controls. They also caused more worry (P less than 0-04) and put other than food more ofter in their mouths (P less than 0-002). There were no significant differences in the age of walking, and the ages of becoming clean and dry between cases and controls. However, poisoning-children had significantly more accidents and hospital admissions than did controls. The relevance of these findings, particularly in relation to the important role of family stress, to the aetiology of accidental poisoning in childhood is discussed.
Chlorpromazine-induced haemolytic anaemia in anorexia nervosa
Authors: How J , Davidson R J
Published: December 2008

Two patients with anorexia nervosa who developed progressive haemolytic anaemia during chlorpromazine therapy are presented. In each case, withdrawal of the drug alone led to a prompt haematological response. Drug-induced oxidant damage is proposed as being the underlying haemolytic mechanism.
Staphylococcal septicaemia with disseminated intravascular coagulation associated with acupuncture
Authors: Izatt E , Fairman M
Published: December 2008

A case of disseminated intravascular coagulation due to staphylococcal septicaemia is described in which the source of infection was likely to have been acupuncture therapy.
Successful treatment of Pseudomonas aeruginosa septicaemia and meningitis with neutropenia—the presenting feature of hypogammaglobulinaemia
Authors: Johnston P G , Speller D C
Published: December 2008

A neutropenic child of 20 months suffered generalized infection with Pseudomonas aeruginosa, involving the bloodstream and the meninges. This was successfully treated with intravenous and intrathecal antibiotics and granulocyte transfusions before granulopoiesis recovered spontaneously. No immunoglobulin replacement was given during the acute episode, as the diagnosis of X-linked hypogammaglobulinaemia was made subsequently.
Myxoedema ascites
Authors: Turner J A , Rapoport J
Published: December 2008

A case of myxoedema ascites complicating ischaemic heart disease is reported. Partial thyroid hormone replacement therapy, given slowly, eventually produced a diuresis and complete resolution of the ascites after a delay of 4 weeks.
Vertebral osteomyelitis due to Pseudomonas aeruginosa
Authors: Denham M J , Goodwin C S
Published: December 2008

A case of vertebral osteomyelitis due to Pseudomonas aeruginosa is described and the problems of diagnosis and treatment discussed.
Perioperative antibiotic prophylaxis and prosthetic valve endocarditis
Authors: Ward C , Jephcott A E , Hardisty C A
Published: December 2008

A study of twenty-five cases of prosthetic valve endocarditis suggests that the antibiotics used for perioperative prophylaxis may alter the type and antibiotic sensitivity of organisms which subsequently infect the artificial valves. Based on the results of this study, the authors have been able to modify their prophylactic regime to encompass these organisms and to predict the antibiotics most likely to be effective in the treatment of prosthetic valve endocarditis in their unit. No single prophylactic or therapeutic regime will be equally effective in all centres, but by examining the different types and sensitivities of bacteria which cause prosthetic valve endocarditis in a locality, antibiotic regimes can be chosen which best suit the local situation.
The cellular structure of bronchial carcinoids
Authors: Marks C , Lamberty J
Published: December 2008

A histological and electronmicroscopic study of bronchial carcinoids indicated that these tumours are argyrophilic in keeping with their occurrence in tissue of embryologically foregut origin. Normal bronchi contain cells that resemble, in their electronmicroscopic content, intestinal Kultschitzky-type cells. Characteristic of the carcinoid cell is the presence of intracellular neurosecretory granules seen on electronmicroscopy despite the apparent absence of argentaffin granules under light microscopy.
Diaphragmatic flutter
Authors: Corbett C L
Published: December 2008

A case is reported of diaphragmatic flutter with an unusually long duration of symptoms. The patient described demonstrates many of the classical features of this disorder.
Hepatoma causing a massive tumour embolus
Authors: Dajani Y F
Published: December 2008

A case of hepatoma is reported, with a typical clinical setting but a most unusual and dramatic final episode. A massive tumour embolus weighing 30 g became arrested on the tricuspid valve, resulting in acute circulatory failure.
Osteoporosis in childhood
Authors: Dent C E
Published: December 2008

Osteoporosis is defined as 'too little normal bone', the disorder being rarer in children than adults. The varied forms in childhood can be classified as those secondary to some other disease and primary forms of the disorder which include the genetically determined osteogenesis imperfecta types and idiopathic forms of osteoporosis. A plea is made for greater clinical application in attempting to discriminate differing forms of these primary disorders. Osteogenesis imperfecta it is argued is a heterogeneous condition with the evidence favouring both dominantly and recessively transmitted forms in different kindreds. Another possible osteogenesis imperfecta variant is characterized by dwarfing, scoliosis and peculiar cystic lesions of the proximal humeri. Idiopathic juvenile osteoporosis is a term reserved for the acute osteoporosis beginning in the immediate prepubertal years and may differ in its cause from idiopathic osteoporosis beginning rather earlier in childhood. It is emphasized that immobilization osteoporosis is of very great importance and may become superimposed upon other osseous dysplasias. A complete understanding of these conditions will be helped by elucidation of the basic underlying defects in collagen and other constituents of bone matrix.
Perthes' disease and multiple epiphyseal dysplasia
Authors: Griffiths H E , Witherow P J
Published: December 2008

Five atypical cases were observed amongst ninety children with Perthes' disease, ten of whom had bilateral hip joint involvement. All five were boys, four being under 4 years of age. Four had bilateral hip joint disease, four presented with hip pain, three showing some degree of retardation of bone growth. In one case the hip disorder was familial, and in four there were bony abnormalities elsewhere. Despite the absence of the classic signs of multiple epiphyseal dysplasia, a mild form of this condition is a possible alternative diagnosis for these children. Racial and familial differences are known in the prevalence of Perthes' disease which itself may represent a dysplasia. The pathogenesis of Perthes' disease is still uncertain, although some abnormality of the blood supply to the proximal femoral epiphysis is postulated. That such a vascular defect may be engrafted on to multiple epiphyseal dysplasia is possible, with subsequent joint degeneration which may come to resemble Perthes' disease either clinically or radiologically. A plea is made for the closer study of young children presenting with what may seem to be atypical Perthes' disease.
Skeletal abnormalities in homocystinuria
Authors: Brenton D P
Published: December 2008

The skeletal changes of thirty-four patients with the biochemical and clinical features of cystathionine synthase deficiency are described. It is emphasized that there is clinical evidence of excessive bone growth and the formation for bone which is structurally weaker than normal. The similarities and differences between this condition and Marfan's syndrome are stressed and the possible nature of the connective tissue defect leading to the skeletal changes discussed. The most characteristic skeletal changes in homocystinuria are the skeletal disproportion (pubis-heel length greater than crown-pubis length), the abnormal vertebrae, sternal deformities, genu valgum and large metaphyses and epiphyses.
A review of the osteopetroses
Authors: Beighton P , Horan F , Hamersma H
Published: December 2008

The osteopetroses are a group of conditions which are characterized by varying combinations of bony sclerosis and modelling defects. Classical osteopetrosis may be inherited as an autosomal dominant or autosomal recessive: the former variety is benign, heterogeneous and comparatively common, while the latter is precocious, potentially lethal and rare. Many other craniotubular dysplasias and hyperostoses are loosely grouped with the osteopetroses. The commonest of these is the autosomal dominant form of craniometaphyseal dysplasia, while the others which are well known include Pyle disease, and van Buchem disease. Sclerosteosis is a progressive condition in which massive cranial thickening is associated with syndactyly and gigantism. Each of these disorders has specific clinical and radiographic features, which permit recognition. Diagnostic accuracy is crucial for treatment, prognostication and effective genetic management.
Information and prescribing from the hospital doctors' viewpoint
Authors: Hunter K R
Published: December 2008

The requirements of a hospital doctor are viewed under the headings of 'active' and 'passive' information. The emphasis is placed on the practical value of information aimed at the prescribers, and the conclusion reached is that the information should be disease- rather than drug-orientated.
Hospital pharmacy information centres and their role as suppliers of information
Authors: McNulty H
Published: December 2008

The development of the drug information services within the hospital area is described from its origin in America. The services currently available in the NHS are outlined and a description of the type of enquiries handled is given.
Information centres in the pharmaceutical industry—the prime source of drug information
Authors: Kenny E C
Published: December 2008

The case is argued that the prime source of information is the manufacturing company. The medical information department of an average-sized company is used as a model to support this argument.
Tumoral calcinosis: a manifestation of extreme metastatic calcification occurring with 1, alpha-hydroxycholecalciferol therapy
Authors: Walker G S , Davison A M , Peacock M , McLachlan M S F
Published: December 2008

Two cases are reviewed, both of which developed tumoral calcinosis whilst receiving 1, alpha-hydroxy-cholecalciferol therapy. Tumoral calcinosis is an extreme form of peri-articular calcification, and its occurrence in patients with chronic renal failure is unusual. These peri-articular masses developed around the shoulders in both patients, and the action of 1, alpha-hydroxycholecalciferol as a possible factor promoting this form of metastatic calcification is discussed.
Cytomegalovirus infection in the neonate and its prevention
Authors: Stern H
Published: December 2008

About 0.5% of infants are infected in utero with cytomegalovirus (CMV). As many as 20% become mentally retarded and a further substantial proportion suffer lesser degrees of brain damage. The need for a vaccine is greater than in the case of rubella. A live, tissue culture-adapted strain of CMV has been shown to produce neutralizing antibody in volunteers without significant side effects or detectable virus excretion. The problems of developing such a vaccine for use in man, namely, attenuation, antigenic differences among virus strains, reactivation of latent infection and oncogenicity, are briefly discussed.
Inflammation in human skin induced by ultraviolet irradiation
Authors: Plummer N A , Hensby C N , Greaves M W , Black A K
Published: December 2008

Pharmacologically active mediators of inflammation were obtained from suction bullae raised on normal and ultraviolet B (290-320 nm) inflamed human abdominal skin. The exudates obtained from the bullae were examined by superfusion cascade bioassay, by radioimmunoassay for PGF2alpha and by column, thin-layer and gas-liquid chromatography. Ultraviolet B (u.v.-B) irradiation of human skin produced an erythema which appeared after 2 hr, increased in severity up to 24 hr and persisted for more than 48 hr. Bioassayable and radioimmunoassayable prostaglandin activity was elevated at 6 hr, was maximal at 24 hr and had returned to normal 48 hr. Topical application of indomethacin suppressed both the erythema and the increased concentration of PGF2alpha as measured by radioimmunoassay. Chromatographic studies confirmed increased prostaglandin activity at 6 and 24 hr and in addition demonstrated an increase in arachidonic acid-like activity. The results suggest that prostaglandins may play an important role between 6 and 24 hr of u.v.-B-induced erythema. Whether the reduction of erythema by indomethacin can be partially or wholly attributable to inhibition of prostaglandin biosynthesis is uncertain.
A temporary biological dressing in the treatment of varicose ulcers and skin defects
Authors: Kaisary A V
Published: December 2008

Corethium 2 has been known to be a valuable biological dressing which encourages re-epithelization in cases of tissue loss, especially in varicose ulcers. It ensures a superior quality of healed tissue even in difficult chronic cases. It also reduces the overall treatment time and can be used as an out-patient dressing.
Placental transfer of lead and its effects on the newborn
Authors: Clark A R L
Published: December 2008

Following delivery, blood was taken from 122 mothers and their infants' cords for estimation of lead, haemoglobin, packed cell volume and mean corpuscular haemoglobin concentration. All were resident in Kasanda, a township within a radius of 3000 metres of Brokin Hill Lead Mine and Smelter, Zambia, where the annual mean atmospheric lead concentration was 9.6 microgram/m3 and the soil lead concentration 100-9400 p.p.m. Their mean blood levels were high, being 41.2 microgram and 37 microgram/dl for mothers and infants respectively, with a significant correlation (r = 0.77, P less than 0.001). Thus an infant's blood lead at birth closely follows that of its mother even at high values. The increased lead level transfer, however, did not appear adversely to affect the birth weight or red cell values of the newborn. Cord blood lead levels are being used in Broken Hill to monitor a community's exposure to lead.