bluuebunny/crossref_metadata_2025 huggingface dataset:
Idiopathic pulmonary haemosiderosis: report of two cases and review of the literature
Authors: Bailey P , Groden B M
Published: December 2008

Idiopathic pulmonary haemosiderosis (IPH) is a rare disorder affecting mainly children and adolescents, and is usually fatal. However, there is increasing evidence that the aetiology of this condition is immunological, and that immunosuppressives may prolong remission.

Two cases are reported, one of which has the atypical feature of a malabsorption syndrome. This has not been previously reported. The literature is reviewed and current ideas on the postulated immunological basis to IPH are discussed.
Central circulatory responses in normotensive and hypertensive pregnancy
Authors: Lees M M
Published: December 2008

Haemodynamic responses in normotensive pregnancy in the antenatal phase show that cardiac output is elevated by the end of the first trimester, and remains elevated throughout pregnancy, although it may fall very slightly at the end of the third trimester of pregnancy. Heart rate remains virtually static throughout pregnancy, although it may fall very slightly at the end of the third trimester of pregnancy. Arterial blood pressure remains virtually unaltered. During labour in patients with traditional anaesthesia, cardiac output is elevated by 40% overall at the end of the labour, and this rise may be as much as 60% in the immediate post-partum period. Patients with epidural analgesia show no overall rise in cardiac output throughout labour. Following Caesarean section there may be massive rises in cardiac output.

In patients who become hypertensive as a result of pregnancy, there are marked individual patterns. These different groups show patients with elevated levels of cardiac output, patients with a pure elevation of systemic vascular resistance, and a third group in which there is elevation of both resistance and output.

It seems certain that different syndromes are occurring, the theoretical explanations for which are discussed.
Cardiac disease in pregnancy
Authors: Petch M C
Published: December 2008

The problems encountered in the management of pregnant patients with valvular, congenital and ischaemic heart disease are described with the help of illustrative cases. The increased incidence of cardiac dysrhythmias in pregnancy is also discussed.
The respiratory response to pregnancy
Authors: Milne J A
Published: December 2008

The respiratory response to pregnancy appears to be largely mediated by the action of progesterone and, perhaps to a lesser extent, oestrogens, at least in the first and second trimesters. The mechanical effects of the gravid uterus cause relatively little change in pulmonary mechanics, although finer changes in airways function require further investigation.

Dyspnoea during pregnancy is also probably hormone-mediated but the exact temporal relationship between hormone status, functional change and the development of symptoms is not yet clearly defined.
Acute renal failure due to non-traumatic rhabdomyolysis
Authors: Chugh K S , Nath I V S , Ubroi H S , Singhal P C , Pareek S K , Sarkar A K
Published: December 2008

Seventeen patients with acute renal failure of diverse aetiology showed myoglobinuria and elevated levels of serum creatine phosphokinase (mean 119·2 Sigma u./ml) and adolase (mean 88·5 Sibley-Lehninger (SL)u./ml), indicating the presence of diffuse muscle cell injury. The primary conditions which led to rhabdomyolysis and acute renal failure were burns, eclampsia, prolonged labour, crush injury, epileptiform convulsions, status asthmaticus, viral myositis and intoxication with chemicals including copper sulphate, mercuric chloride and zinc phosphide. In 10 non-myoglobinuric patients with acute renal failure, serum creatine phosphokinase was normal (mean 8·9 Sigma u./ml) and serum aldolase was only slightly elevated (mean 11·2 SL u./ml). Although uric acid was elevated in both groups, the values were significantly higher in myoglobinuric (mean 0·728 ± 0·199 mmol/l) compared to non-myoglobinuric patients (mean 0·583 ± 0·093 mmol/l). During the oliguric phase, hypocalcaemia was observed in 82·2% of myoglobinuric patients and in 20% of non-myoglobinuric patients. Ten out of 15 patients with myoglobinuric renal failure developed hypercalcaemia during the diuretic phase whereas only 3 non-myoglobinuric patients showed a transient hypercalcaemia. Although the mean serum potassium was somewhat higher in the myoglobinuric patients, the difference between the 2 groups was not significant. It is concluded that acute renal failure associated with non-traumatic rhabdomyolysis is not infrequent and may occur in a variety of conditions where gross evidence of muscle injury is lacking.
Neutrophil function and diagnosis of pre-leukaemic states
Authors: Houghton J B
Published: December 2008

Haemopoietic dysplasia is a condition which often precedes the development of acute non-lymphocytic leukaemia. Before this event, however, patients are at risk from severe infections even in the absence of neutropenia. This paper describes 3 patients with haemopoietic dysplasias in whom neutrophil microbicidal activity was deficient in vitro. The important abnormality appeared to be defective release of myeloperoxidase into the phagocytic vacuole. Two of these patients suffered from numerous baterial infections.
Feminizing adrenocortical carcinoma in a postmenopausal woman
Authors: Barcelo B , Abascal J , Ardaiz J , Gil P , Colas A , Menendez J , Inchausti J L
Published: December 2008

The successful surgical removal of a feminizing adrenal tumour in a postmenopausal woman is described. Most of these tumours are malignant and the pathological findings and the biological behaviour of the tumour frequently do not correlate, so that a careful follow-up is necessary. In the presence of vaginal bleeding in a postmenopausal woman endometrial carcinoma should be considered. If this has been ruled out and if oestrogens are elevated with low plasma gonadotrophins, a feminizing ovarian or adrenal tumour should be considered.
Neuroblastoma in adults
Authors: Rowe P H , Oram J J , Scott G W
Published: December 2008

Two cases of neuroblastoma are described in patients who were both more than 25 years old when their symptoms first appeared. The behaviour of this tumour appears less aggressive in adults than in children, but the cases presented illustrate its resistance to chemotherapy and radiotherapy, and surgery is suggested as the first line of treatment in adults, even if the growth cannot be removed completely.
Failure of treatment in chronic dermatophyte infections
Authors: Hay R J
Published: December 2008

A proportion of dermatophyte infections fail to respond to normally adequate courses of griseofulvin and topical antifungal therapy. The organism Trichophyton rubrum was isolated from 96% of 50 patients studied, but no instances of in vitro resistance were seen. Of these patients, 57% had an underlying condition, commonly hay fever/asthma, atopic eczema, collagen disease or ichthyosis. Defective delayed type hypersensitivity responses and leucocyte migration inhibition to the specific antigen, trichophytin, were demonstrated. Immediate type hypersensitivity was seen in 58% and this was partially suppressible with chlorpheniramine and cimetidine. The relationship between these abnormalities and failure of treatment is discussed.
Aspergillus fumigatus and lung disease
Authors: Turner-Warwick M
Published: December 2008

The range of clinical presentations of lung diseases associated with Aspergillus spp. is great. The conditions are very frequently misdiagnosed but errors should be avoided if the possibility of a fungal cause is considered and simple immunological tests undertaken. Often no more than skin-prick tests and serum precipitins need to be done. In many cases, fungus is not isolated from the sputum and negative results do not exclude the possibility of A. fumigatus as the causal agent. Treatment often results in marked clinical improvement and there is evidence that suppression of recurrent episodes of bronchopulmonary aspergillosis prevents progressive lung damage.
Ketoconazole, an oral antifungal: laboratory and clinical assessment of imidazole drugs
Authors: Borelli D , Bran J L , Fuentes J , Legendre R , Leiderman E , Levine H B , Restrepo-M A , Stevens D A
Published: December 2008

Miconazole, a parenterally administered imidazole antifungal agent has been shown to produce responses in systemic fungal infections in man. Ketoconazole, an analogue, can be given by mouth. It is inhibitory in vitro at low concentrations to most fungi. Blood levels after oral administration to animals and man greatly exceed these inhibitory concentrations for several hours. The efficacy of this drug has been demonstrated in animal models. Initial clinical evaluation has produced responses to therapy with 200–400 mg/day in 13 of 16 evaluable patients with systemic and superficial fungal infections, involving 10 fungal pathogens. No toxicity has been noted to date in these human studies. Ketoconazole is a promising agent needing further extensive evaluation.
The influence of carbohydrases on the growth of fungal pathogens in vitro and in vivo
Authors: Pope A M S , Davies D A L
Published: December 2008

Mixtures of mycolytic enzymes from various sources release protoplasts from living fungal tissue under suitable conditions. Such enzyme mixtures obtained from Coprinus comatus (mycolase I), Physarum polycephalum (mycolase II) and Lycoperdon pyriforme (mycolase III) are of low toxicity in mammals when given parenterally and are able to cure experimental systemic fungal infections in mice when administered alone or in conjunction with normally ineffective levels of conventional antimycotic drugs such as amphotericin B. The effect is believed to be due to enzymic degradation of the fungal cell wall either killing the fungus directly or enhancing activity of existing antifungal agents by increasing access to the cell interior.
Sensitivity of Candida albicans from patients with chronic oral candidiasis
Authors: Holbrook W P , Kippax R
Published: December 2008

Many patients with oral candidiasis respond very slowly or not at all to therapy with amphotericin. Strains of Candida albicans were collected from 17 patients clinically resistant and from 15 who responded to a normal course of amphotericin treatment. Minimal inhibitory concentrations (MIC) determined on diagnostic sensitivity test agar plates gave values of: amphotericin 0·5 mg/l; nystatin 50 i.u./ml; chlorhexidine 12.5 mg/l. No clear MIC could be determined with plates containing miconazole. No difference was noted in MIC values between the 2 groups of patients. Tube-dilution tests in Sabouraud's broth gave MIC values of: amphotericin 0·25 mg/l; nystatin 12·5 i.u./ml; chlorhexidine 1·5 mg/l; miconazole 8–32 mg/l; ketonazole 64 mg/l. Persistence of oral candidiasis is not an indication of infection with resistant organisms. Despite difficulties in in vitro sensitivity testing of miconazole a clinical trial of the drug for treating oral candidiasis is indicated.
A comparative study of adverse factors in meningococcaemia and meningococcal meningitis
Authors: Ansari B M , Davies D B , Boyce J M H
Published: December 2008

In a retrospective study, a comparison was made of clinical and laboratory data in 14 patients with meningococcaemia and 40 patients with meningococcal meningitis. Significant differences were found in duration of symptoms, onset of purpura, presence of shock, initial WBC, ESR, and serum fibrin degradation products. The overall mortality rate in this series was 7%, 4 patients with meningococcaemia dying, but none with meningococcal meningitis. This study indicates the importance of clinical and pathological grading of patients with meningococcaemia. Death occurred only in patients presenting with 3 or more of the adverse factors detailed.
Protein-losing enteropathy due to gastro-intestinal amyloidosis
Authors: Hunter A M , Campbell I W , Borsey D Q , Macaulay R A A
Published: December 2008

A case is described of a patient who presented with severe oedema due to protein-losing enteropathy caused by amyloidosis secondary to bronchiectasis.
Clinical and epidemiological aspects of methylmercury poisoning
Authors: Bakir F , Rustam H , Tikriti S , Al-Damluji S F , Shihristani H
Published: December 2008

An opportunity to study the effects of methylmercury poisoning in humans was provided by the large outbreak in Iraq in 1971-2. In adults, poisoning resulted from the ingestion of home-made bread prepared from methylmercury-treated seed grain and there was a highly significant correlation between the amount of bread ingested and blood mercury levels. Poisoning in infants resulted either from prior exposure in utero or from suckling or both. Blood mercury levels were higher in infants and children than in adults.

There was no increased incidence of congenital defects. Symptoms and signs of poisoning and histopathological changes were mainly confined to the CNS. Symptoms developed, on average, 1-2 months after exposure. In children there was mental retardation with delayed onset of speech and impaired motor, sensory and autonomic function. Severely affected children were blind and deaf. In adults, the clinical picture could be classified as 1, mild (mainly of sensory symptoms) 2, moderate (sensory symptoms accompanied by cerebellar signs) and 3, severe (gross ataxia with marked visual and hearing loss which, in some cases, progressed to akinetic mutism followed by coma). Grades 1 and 2 carried a better prognosis thant grade 3.

Interference with transmission at the myoneural junction was found in 14% of patients studied. There was no evidence of peripheral nerve involvement per se and sensory symptoms may be of central origin.

The clinical differences between the Iraqi and Japanese outbreaks may be a result, in part at least, of the severe, prolonged and continuous exposure which occurred in the latter outbreak. Improvement was observed among the mild and moderate group. Treatment with chelating agents, thiol resin, haemodialysis and exchange transfusion lowered blood mercury concentrations but produced no convincing clinical benefit. To be effective, treatment may need to be instituted soon after exposure.
Dermatitis herpetiformis and diabetes mellitus
Authors: Holt S , Blackwell J N
Published: December 2008

Three out of 4 patients with coexistent diabetes mellitus and dermatitis herpetiformis (DH) developed severe renal failure which resulted in death in 2 of them. Diabetes mellitus and DH may coexist more frequently than would occur by chance, and such patients may run an increased risk from severe renal complications of diabetes.
The effect of oral cimetidine on the basal and stimulated values of prolactin, thyroid stimulating hormone, follicle stimulating hormone and luteinizing hormone
Authors: Nelis G F , Van de Meene J G C
Published: December 2008

The effect of cimetidine on the basal values of PRL, TSH, FSH and LH and on the TRH/LHRH-stimulated values of these hormones was investigated in patients with peptic ulcer. No difference was found between the values before, during or after cimetidine maintenance treatment. To evaluate whether a rise in PRL occurs during the early phase of cimetidine treatment, daily estimations were made of basal PRL values during the first week of cimetidine adminstration in volunteers. No significant difference was found. It is concluded that oral cimetidine treatment has no influence on the basal and stimulated values of PRL, TSH, FSH and LH.
Spontaneous pneumonediastinum associated with pulmonary cavitation
Authors: Qureshi S A
Published: December 2008

Two patients developed spontaneous pneumomediastinum. One had a tuberculous cavity and the other an emphysematous bulla.
Multiple sclerosing haemangiomas of the lung
Authors: Joshi K , Shankar S K , Gopinath N , Kumar R , Chopra P
Published: December 2008

A case of mulitple sclerosing haemangiomas of the lung is described from a 40-year-old woman, who presented with haemoptysis. A chest X-ray revealed multiple circumscribed coin lesions in both lungs. A right upper lobectomy was done for diagnosis. The patient has remained well for 2 years after surgery. Multiplicity of tumour masses of pulmonary sclerosing haemangiomas is extremely rare and, although benign, may pose a great diagnostic problem.
Site-specific colonic carcinoma in identical twins
Authors: Whitehead S
Published: December 2008

The development of identically sited carcinomas of the colon in monozygotic twins is described. Presentation occurred with 2 years of each other. They are discussed in the context of the cancer-family syndrome.
A case of Haemophilus parainfluenzae meningitis in an adult associated with acute myositis
Authors: Timmis A , Nyholm E , Dawson R J
Published: December 2008

A rare case of Haemophilus parainfluenzae meningitis in an adult is reported. It was associated with acute myositis. This is thought to be the first report of such an association.
Demeclocycline therapy for resistant oedema in advanced cardiac failure
Authors: Bonser R S A , Ghose R R
Published: December 2008

A patient with long-standing ischaemic heart disease and severe low output congestive cardiac failure received numerous diuretics, which gradually became ineffective. Resistant oedema was treated by adding demeclocycline to the current diuretic regime of frusemide and metolazone. Diuresis resulted, oedema disappeared and body weight fell. This drug combination was continued without complication for a further 6 months until his death.
Para-aminosalicylic acid-induced hypoglycaemia in a patient with diabetic nephropathy
Authors: Dandona P , Greenbury E , Beckett A G
Published: December 2008

A 62-year-old Indian with diabetic nephropathy controlled with metformin, developed miliary tuberculosis for which he was treated with rifampicin, isoniazid and ethambutol. Soon afterwards he developed cholestatic hepatitis and visual disturbance. Rifampicin and ethambutol were stopped. Streptomycin caused vertigo and had to be stopped. The introduction of para-aminosalicylic acid (PAS) led to hypoglycaemic coma. Metformin was stopped. Hypoglycaemic coma recurred. PAS was stopped and the patient’s blood glucose concentrations became normal. Treatment with isoniazid and ethambutol led to total recovery from pulmonary tuberculosis. The induction of hypoglycaemia with PAS in this patient suggests a potential role for PAS in the treatment of diabetes mellitus.
Gentamicin extraction from an anuric patient by combined haemodialysis and charcoal haemoperfusion
Authors: Wright N , Bhamjee A
Published: December 2008

A 39-year-old woman who developed acute renal failure following intra-abdominal sepsis was treated with gentamicin. Her serum concentrations reached potentially toxic levels. Combined haemoperfusion and haemodialysis removed approximately 70% of the given drug and the patient made a complete recovery.
Lateral meningocele and defect of abdominal wall
Authors: Placzek M M , MacKinnon A E
Published: December 2008

A case of lateral meningocele associated with deficiency of the thoraco-abdominal wall is reported. It is suggested that both of these defects are due to interference with the development of the paraxial mesoderm by a single injury.
Campylobacter enteritis in Chelmsford
Authors: Bradshaw M J , Brown R , Swallow J H , Rycroft J A
Published: December 2008

During one year, out of 1829 faecal specimens examined at the Chelmsford Public Health Laboratory, campylobacters were isolated from 109 (6%), 21 of the positive cultures were from hospital in-patients and 3 were from hospital staff. The remaining 85 isolates were from specimens sent in by general practitioners.

The authors’ figures show a marked season variation with most of the infections occurring from June to September. The highest incidence (36%) was in the 20 to 30 age group, 99% of patients had diarrhoea, usually watery, occasionally explosive, and 9% had visible blood in their stools. Eighteen per cent. of patients had abdominal pain, 5 of the 21 hospital in-patients underwent abdominal surgery. Fifty-nine faecal specimens were examined microscopically and 30 of these had blood and pus cells or pus cells alone. Three patients had rectal biopsies showing a nonspecific colitis, 11 patients had recently been abroad.
Unusual variants in the presentation of temporal arteritis
Authors: Cherry J E , Pearce J M S
Published: December 2008

A retrospective study was made of 96 patients diagnosed as cranial arteritis of whom 32 were accepted using strict clinical criteria or a positive temporal artery biopsy. Unusual presentations of fever, psychiatric illness, headache-free patients and a ‘normal’ ESR are described. The recognition of these variations is important in the early diagnosis of temporal arteritis.
The treatment of ‘shooting’ pain
Authors: Swerdlow M
Published: December 2008

Anticonvulsant drugs were given to 70 patients suffering from lancinating pains of various clinical aetiologies. Serum drug estimations were used to ensure that an effective dose level was achieved. In about 66% of the cases, treatment produced some diminution in the intensity and/or frequency of the "flashes" of pain. The neurophysiological and pharmacological rationales are briefly explained. It is concluded that this use of anticonvulsant agents merits further study.
Small cell carcinoma of the lung
Authors: Morgan P G M
Published: December 2008

Over a 5-year period 230 cases of small cell carcinoma presented to Brompton Hospital, London. The male to female ratio was 2.5:1 and 39% had evidence of extrathoracic disease. Forty-five patients were untreated and had a median survival of 70 days. The 5-year survival for surgery and radiotherapy was 6.6% and 4.2% respectively. Of 13 patients treated with chemotherapy the median survival was 285 days. The factors which influence survival are described.
Acute poisoning due to Wright’s vaporizing fluid
Authors: Wiseman H M , Turner W M L , Volans G N
Published: December 2008

A 3-year survey is reported of acute poisoning by Wright’s Vaporizing Fluid which covered a change in formulation from 90% cresol to 10% chlorocresol. Of 160 children (average age 2.5 years) and 12 adults, 21.5% had moderate symptoms, 7.5% had severe symptoms and one child died. Where incidents involved the old formulation very few patients escaped without symptoms and over 50% of thm had skin burns or moderate systemic symptoms. With the new formulation over 50% of the patients were asymptomatic and skin burns were uncommon. However there was no significant difference in the incidence of severe systemic symptoms between the formulations. The new formulation appears safer when small amounts of the fluid are ingested, but when larger amounts are involved it is potentially lethal. The case history of the fatal poisoning is presented.
Cimetidine treatment for the prevention of recurrence of duodenal ulcer: an international collaborative study
Authors: Burland W L , Hawkins B W , Beresford J
Published: December 2008

Comparison of cimetidine and placebo in the prevention of recurrence of ulceration was carried out in the study of 696 patients with recently healed duodenal ulcers. Treatment with cimetidine 400 mg at bedtime or twice daily for up to 12 months very significantly reduced recurrence of symptomatic ulceration. Asymtomatic ulceration occurred in treated and untreated patients but was found significantly less often in cimetidine-treated patients. There were no serious untoward effects of cimetidine treatment. Only 3 patients (0.8%) were withdrawn for possible drug-related reasons. Evidence from other studies suggests that the natural history of duodenal ulcer remains unaltered when cimetidine treatment is stopped after one year. Investigations have been planned to study the efficacy and safety of longer periods of treatment.
Unusual presentation of cholangiocarcinoma
Authors: Marigold J H , Horton L W L , Thompson R P H
Published: December 2008

A patient who presented with dysphagia was found to have a cholangiocarcinoma, with metastases in the para-oesophageal lymph nodes. Although dysphagia has been described as a presenting feature of some metastatic carcinomas, to the authors’ knowledge, there have been no reports of it as a presenting symptom of a cholangiocarcinoma.
Thrombophlebitis migrans: a further systemic complication of ulcerative colitis
Authors: Elliott H L
Published: December 2008

Thrombophlebitis migrans complicating ulcerative colitis has been reported only once previously when it occurred in a patient with chronic and extensive bowel disease. This report describes the occurrence of thrombophlebitis before any bowel upset in a patient who proved to have only a mild colitis, and no laboratory evidence of hypercoagulability. It seems that thrombophlebitis migrans is a further systemic complication of ulcerative colitis, and that its occurrence may precede overt bowel disease.
Pernicious anaemia and hypogammaglobulinaemia in a patient with severe infantile kyphoscoliosis
Authors: Lee F I , Norfolk D R
Published: December 2008

A 27-year-old man with severe infantile kyphoscoliosis suffered from recurrent respiratory tract infections during childhood and early adult life. He deteriorated and was found to have pernicious anaemia and common variable immunodeficiency with hypogammaglobulinaemia and impairment of cell-mediated immunity. Marked clinical improvement has followed the institution of effective gamma-globulin replacement.
Hypersensitivity and jaundice due to azathioprine
Authors: Davis M , Eddleston A L W F , Williams R
Published: December 2008

A patient is described who suffered hypersenitivity reactions (anorexia, nausea and vomiting) as well as cholestatic jaundice from therapy with azathioprine. Evidence is given that the 2 reactions were mediated by different portions of the azathioprine molecule.
Partial nodular transformation of the caudate lobe of the liver presenting with ascites
Authors: Fletcher M S , Wight D G D
Published: December 2008

Partial nodular transformation is a rare condition which effects the perihilar portion of the liver and may cause chronic portal hypertension. This case report describes an elderly women in whom the condition was confined to the caudate lobe, which had become greatly enlarged and, by external compression of th portal vein at the hilum of the liver, had caused portal vein thrombosis and subsequent acute ascites.
Nephrotic syndrome complicated by tubular dysfunction. Case report and review of possible mechanisms
Authors: Luder A S , Cohen S L , Fisher C
Published: December 2008

A 35-year-old-man presented with nephrotic syndrome due to mesangiocapillary glomerulonephritis; he later developed a potassium-losing state, generalized amino aciduria and glycosuria. Clinical and biochemical improvement occurred after steroid therapy. The possible pathophysiological mechanisms are discussed.
Successful renal transplantation in primary hyperoxaluria
Authors: O’Regan P , Constable A R , Joekes A M , Kasidas G P , Rose G A
Published: December 2008

A successful live related renal transplant in a 29-year-old male patient with Type 1 primary hyperoxaluria, who remains well 32 months postoperatively, is described. The plasma oxalate and exchangeable oxalate pool before transplantation were 160 mumol/1 and 4429 mumol respectively. Since the transplant these have been greatly reduced although they remain elevated above the normal by a factor of 2. Pyridoxine therapy and the avoidance of oxalate-rich foods have been effective in maintaining these reduced levels and the 24-hr urinary oxalate excretion has also been maintained close to normal levels on this regime. After review of the previously reported transplants in patients with well documented primary hyperoxaluria and from the experience with this patient, the following guidelines for successful renal transplantation in primary hyperoxaluria are suggested: transplants should only be carried out in those who have shown a response to adequate pyrodoxine therapy; frequent haemodialysis pre-operatively and during periods of oliguria postoperatively is necessary; oxalate-rich foods should be avoided and a high fluid intake should be maintained after transplantation. If these guidelines are followed there is no contra-indicatin to live related renal transplants in primary hyperoxaluric patients.
Isolated gastroduodenal Crohn’s disease in a ten-year-old girl
Authors: Malleson P
Published: December 2008

The first case of a child with gastroduodenal Crohn’s disease and no other intestinal lesions is described. She presented with persistent anaemia and failure to thrive. There was megaloblastosis due to B12 deficiency secondary to absent intrinsic factor. The diagnosis was delayed for nearly 3 years andthen treatment with steroids and azathioprine resulted in rapid clinical improvement. The diagnostic possibility of Crohn’s disease in unusual sites should be considered in any child with unexplained failure to thrive.
Heparin, free fatty acids and an increased metabolic demand for oxygen
Authors: Jung R T , Shetty P S , James W P T
Published: December 2008

Obese and lean subjects were given heparin with or without Intralipid in order to assess the effect of heparin on plasma concentration of free fatty acids (FFA) and oxidative metabolism. The FFA response depended on the triglyceride concentration and was associated with a prompt rise in oxygen consumption. Plasma catecholamines did not alter after heparin and the increase in oxygen uptake was proportional to the rise in FFA. The use of heparin, therefore, has metabolic disadvantages which may outweigh the potential benefits, for example in the management of myocardial infarction where heparin may increase the metabolic demand on the heart by increasing FFA levels.
Malaria: a laboratory risk
Authors: Bending M R , Maurice P D L
Published: December 2008

A case is described of malaria contracted in a clinical laboratory by accidental self-inoculation with infected blood.
Primary meningitis caused by Bacteroides fragilis and Fusobacterium necrophorum
Authors: Islam A K M S , Shneerson J M
Published: December 2008

A fatal case of meningitis due to Bacteroides fragilis and Fusobacterium necrophorum is reported. This appears to be the first case in which meningitis due to these organisms was not secondary to a disease elsewhere in the body. The organisms are difficult to culture and strict anaerobic methods should be used whenever they are suspected. Intravenous metronidazole is probably the antibiotic of choice.
Simultaneous presentation of thyrotoxic crisis and diabetic ketoacidosis
Authors: Bridgman J F , Pett S
Published: December 2008

Two patients presented with co-existing development of diabetic ketoacidosis and thyrotoxic crisis. The difficulties of diagnosis and management of such cases are discussed.
The site of protein loss in Schönlein-Henoch purpura
Authors: Waller D G , Dalziel K L
Published: December 2008

Schönlein-Henoch purpura may be complicated by hypoproteinaemia, which in most patients is due to the development of nephrotic syndrome. However, in some proteinuria is insignificant and enteric protein loss has been suggested as the cause. A case with supportive evidence for this is reported.
Hepatoma and obstructive jaundice
Authors: Cleland P G , Adjukiewicz A
Published: December 2008

Three patients with hepatoma are described whose presenting feature was obstructive jaundice.

Recognition of this rare manifestation of hepatoma can establish the diagnosis before surgery.
The hypereosinophilic syndrome—a diagnostic enigma
Authors: Ellul-Micallef R , Mohammed D E , Fenech F F
Published: December 2008

The hypereosinophilic syndrome groups together a number of conditions in which eosinophilia occurs for no apparently identifiable cause. Initial reports indicated a uniformly grave prognosis but recent observations suggest a more favourable outcome in certain cases. Two patients with hypereosinophilic syndrome are described whose course of disease and outcome have been completely different.
Fatal tension pneumoperitoneum due to aerophagy
Authors: Hutchinson G H , Alderson D M , Turnberg L A
Published: December 2008

A case of fetal tension pneumoperitoneum following gastric perforation due to aerophagy is described. Comment is made on the probably pathogenesis.
Diffuse cutaneous involvement and sinus histiocytosis with massive lymphadenopathy
Authors: Woodcock A A , Hart P L
Published: December 2008

Severe skin involvement complicated a case of sinus histiocytosis with massive lymphadenopathy in a young Malay girl. The clinical and histological features of this rare manifestation are described.
Prevention of coronary heart disease: the role of high density lipoproteins
Authors: Miller N E
Published: December 2008

There is now strong evidence that the risk of developing clinical coronary heart disease (CHD) in apparently healthy middle-aged men is inversely related to the plasma high density lipoprotein (HDL) cholesterol concentration. This reflects an underlying relationship between HDL cholesterol concentration and the severity of coronary atherosclerosis. This new information represents a significant development in atherosclerosis research. In the author’s opinion, however, it is not yet justifiable, or indeed possible, to utilize this knowledge in CHD prevention programmes for 3 reasons. Firstly, there is still little prospective information on HDL and CHD in women, in younger subjects and in patients with existing clinical disease. Secondly, although there are at least 2 working hypotheses, a causal relationship between HDL metabolism and atherogenesis has not yet been established. Thirdly, there is still a relative paucity of information on the environmental determinants of HDL concentration and metabolism. Thus, premature attempts at intervention in an uncontrolled manner, and particularly the use of drugs for an HDL-raising effect, might only confuse the issue. While further research is being undertaken, attention should continue to be directed towards other reversible coronary risk factors (including hypercholesterolaemia, hypertension, and cigarette smoking) in CHD prevention programmes.
Problems in implementing a good food and nutrition policy in Britain
Authors: James W P T
Published: December 2008

There is no co-ordinated food and nutrition policy in Britain, primarily because it is still not recognized that diet has an important role to play in the development of many diseases of affluence. The demand for absolute proof of the dietary component of disease on a population level ignores both the innate biological susceptibility in only a portion of the population to a particular nutrient as well as the increasing evidence from studies on non-human primates that diet plays a key role in several conditions including heart disease. Government remains unsure of how to implement its own current recommendations and the traditional paternalistic and conservative approach delays action. Vested interests, seeking only short-term gains, are not confined to industrial concerns. Marketing Boards are allowed almost unfettered freedom to promote nutritionally undesirable eating habits. Health education in schools remains inadequate with most of the involved teachers still promoting incorrect concepts. The medical profession is still unwilling to take a physician maintaining treatment programmes for marginal effects on a public health problem. General practitioners are better able to start practising preventive medicine but they need to be helped by community physicians who should begin on their main task of implementing policies for preventing disease rather than limiting themselves to their current preoccupation with systems analyses and operational research.
Incidence of Legionnaires’ disease in a district general hospital
Authors: Atkinson A R , White R J , Clarke S K , Blainey A D
Published: December 2008

In order to assess the incidence of Legionnaires’ disease in a district general hospital, 90 consecutive patients with pneumonia seen over a 3-year period were investigated. Only 2 patients were found to have Legionnaires’ disease, indicating that it is not a frequent cause of pneumonia in the Bristol area.
Spinal cord ischaemia complicating meningococcal meningitis
Authors: Swart S S , Pye I F
Published: December 2008

An extensive ischaemic cord syndrome developed in a patient with meningococcal meningitis complicated by 2 respiratory arrests but not by any period of prolonged hypotension or other signs of cardiovascular collapse. Excellent functional recovery occurred after intensive rehabilitation.
Jaundice following warfarin therapy
Authors: Jones D B , Makepeace M C , Smith P M
Published: December 2008

A case of intrahepatic cholestatic jaundice following warfarin therapy is described. The patient made a complete recovery on withdrawal on the drug.
Bronchiectasis and Marfan’s syndrome
Authors: Foster M E , Foster D R
Published: December 2008

Marfan’s syndrome is a rare hereditary disorder characterized by skeletal, cardiovascular and ocular abnormalities. Pulmonary abnormalities occur in approximately 10% of patients the commonest being spontaneous pneumothorax and emphysema. A patient is described who had Marfan’s syndrome and bronchiectasis, an association only described on 2 previous occasions in the literature.
Dietary amenorrhoea and subclinical hypothyroidism with elevated TSH responsive to weight gain
Authors: Thomson J A , Ratcliffe W A
Published: December 2008

A case of dietary amenorrhoea associated with the biochemical picture of subclinical hypothyroidism is described. Both the amenorrhoea and the abnormal thyroid function tests reverted to normal on gaining weight.
Experience with cellulose acetate-coated activated charcoal haemoperfusion in the treatment of severe hypnotic drug intoxication
Authors: Crome P , Hampel G , Widdop B , Goulding R
Published: December 2008

A haemoperfusion column containing activated charcoal coated with cellulose acetate was used to treat 7 patients with barbiturate or ethchlorvynol poisoning. Six of the patients showed marked lightening of coma and all showed a significant fall in plasma drug concentration. Plasma drug clearance and platelet loss were similar to those reported for other coated charcoal columns. Cellulose acetate-coated charcoal haemoperfusion may reduce the period of coma in severe poisoning with barbiturates and other hypnotic drugs and thus the morbidity and mortality.
Liver disease in patients with diabetes mellitus
Authors: Foster K J , Griffith A H , Dewbury K , Price C P , Wright R
Published: December 2008

Liver function tests were assessed in 60 unselected out-patient diabetics stabilized on insulin or oral hypoglycaemic agents. Routine liver function tests, particularly plasma concentrations of gamma-glutamyl transpeptidase and alkaline phosphatase were elevated occasionally but rarely to more than twice the upper limit of normal. There was no correlation between measures of diabetic control and results of liver function tests. Twelve (20%) patients had evidence of gall stones, a prevalence above the expected from the community. Fourteen (23%) patients had an abnormally bright liver ultrasound echo pattern, probably indicative of fatty infiltration of the liver. This echo pattern was associated with only a minimal rise in plasma alanine amino transferase and alkaline phosphatase concentrations. It is concluded that functionally significant liver disease is uncommon amongst stabilized diabetic patients.
A comparative study of automated blood pressure recorders
Authors: Rubin P , McLean K , Reid J
Published: December 2008

Four automated blood pressure machines (Arteriosonde 1225, Bosomat 11D, Elag Koln BE 237R and Omron HEM 3) have been compared with each other and with the Hawksley Random Zero Sphygmomanometer in 18 subjects with a wide range of BP. Each form of measurement provided a high degree of internal consistency. The Arteriosonde 1225 consistently recorded systolic and diastolic pressures which were below the values obtained with the Random Zero instrument (P=0.001). The other 3 automated machines recorded BPs which did not differ significantly from the Random Zero or from each other. Heart rate readings did not differ significantly for any of the machines compared to manual recording. The disparity attributable to the Arterisonde could result from its being the only form of measurement to use an ultrasonic rather than a microphonic recording technique. However, the cheaper and more portable automated machines produce results which closely reflect those obtained by using a mercury sphygmomanometer.
Consumption of refined carbohydrate by patients with Crohn’s disease in Tel-Aviv-Yafo
Authors: Silkoff K , Hallak A , Yegena L , Rozen P , Mayberry J F , Rhodes J , Newcombe R G
Published: December 2008

In 27 patients with Crohn’s disease living in Israel the current intake of refined carbohydrate (total sugars) and added sugar is significantly greater than in healthy controls. The dietary survey was retrospective and showed that patients with Crohn’s disease ate 269 g of monosaccharides and disaccharides each day compared with 192 g by matched controls. Similar differences were also found at the onset of the symptoms, 314 g compared with 207 g. These findings were independent of the country of origin or cultural grouping. Several factors are discussed which suggest a secondary rather than causal relationship between sugar consumption and Crohn’s disease.
Recent cases of trench foot
Authors: Ramstead K D , Hughes R G , Webb A J
Published: December 2008

Two cases of cold injury to the lower extremities, ‘trench foot’, are presented. The management is essentially conservative, but in cases of severe damage, particularly in elderly people, amputation must be advised.
The effect of anosmia on smoking habits
Authors: Peatfield R C , Turner J A McM , Sillett R W , McNicol M W
Published: December 2008

Sixteen cigarette smokers who had developed complete anosmia were questioned about their smoking habits. Four subjects increased their cigarette consumption, 8 were unchanged and 4 decreased. The development of anosmia has no consistent effect on cigarette smoking.
Total body potassium depletion and severe myopathy due to chronic liquorice ingestion
Authors: Sundaram M B M , Swaminathan R
Published: December 2008

A 33-year-old patient with hypokalaemia associated with severe myopathy following liquorice ingestion is described. Potassium depletion was confirmed by total body potassium measurements and myopathy was established by electromyography and enzyme studies. The potential hazard of chronic liquorice consumption even as a sweet is illustrated by this case.
Hyperinfection syndrome with Strongyloides stercoralis
Authors: Ali S M , Dormer A E
Published: December 2008

A case is reported of hyperinfection syndrome with Strongyloides stercoralis, with symptoms, signs and radiological appearances which led to a diagnosis of duodenal ulcer.
Comparison of the chronic effects of bendrofluazide, bumetanide and frusemide on plasma biochemical variables
Authors: Gabriel Roger , Baylor Peter
Published: December 2008

Eleven plasma variables have been studied in 18 elderly patients with cardiac oedema treated with bendrofluazide, frusemide and bumetanide, using a fully balanced, cross-over trial design. Bumetanide caused the least disturbance of plasma potassium and bendrofluazide the greatest. Frusemide produced an intermediate effect. The difference between the changes in plasma potassium produced by bumetanide and bendrofluazide was significant (P < 0.02).
Meningitis and bacteraemia due to Listeria monocytogenes in compromised hosts
Authors: Maayan Mosche C , Wajsman Cilla , Nitzan (Zaidenzaig) Yeshayahu
Published: December 2008

The clinical history of 3 adult patients infected by Listeria monocytogenes is presented. One patient with chronic lymphatic leukaemia developed purulent meningitis; the 2 others had chronic renal failure and were undergoing routine haemodialysis. Of the latter, one developed meningitis and the other bacteraemia after receiving 2 blood transfusions. Immuno-suppression, or the underlying disease of the hosts, probably played a role in permitting the infection to establish itself. The rural environment may also have been conducive to the transfer of this particular, rarely infectious, micro-organism to these patients.
Primary hyperparathyroidism and thiazide diuretics
Authors: Klimiuk P S , Davies M , Adams P H
Published: December 2008

Six patients receiving thiazide diuretics were referred for evaluation of mild to moderate hypercalcaemia (serum calcium 2.65-2.98 mmol/l). All patients were considered to be suffering from primary hyperparathyroidism. Withdrawal of the diuretic was followed by a reduction in the serum calcium, one patient becoming normocalcaemia.

The mechanisms responsible for these changes are discussed. In hypercalcaemic patients taking thiazides, it is recommended that the effects of withholding the diuretic should be observed before more radical measures are considered.
Thyroid carcinoma in an autonomously hyperfunctioning thyroid nodule
Authors: Khan O , Maclennan K A , Ell P J , Kurtz A , Williams E S
Published: December 2008

A 44-year-old woman presented with hyperthyroidism and a nodule in her thyroid. 131I-scintigraphy of the gland showed concentration of the tracer within the nodule and suppressed activity in the rest of the gland. Histology of the resected thyroid proved the nodule to be a papillary carcinoma. The presence of carcinoma within an autonomous hyperactive thyroid in a patient with hyperthyroidism has been reported only rarely, and to the authors’ knowledge such a case has never been reported in Great Britain. Furthermore, unlike previously reported cases, the carcinoma was confined solely to the nodule.
Beta-adrenoreceptor blocking drugs and thyroid hormones in hyperthyroid subjects
Authors: Jones M K , Birtwell J , Owens D R , Jones G R , Lewis M
Published: December 2008

Serum thyroid hormone concentrations were measured before and during 10 days’ treatment with atenolol (200 mg/day), acebutolol (400 mg/day), oxprenolol (160 mg/day) and propranolol (160 mg/day) in 24 hyperthyroid patients. During propranolol treatment serum triiodothyronine (T3) concentrations fell significantly (P less than 0.05) but there was no change in thyroid hormone concentrations in the other groups although all patients reported a symptomatic improvement.
Toxic megacolon in ulcerative colitis: a continuing challenge
Authors: Muscroft T J , Warren P M , Asquith P , Montgomery R D , Sokhi G S
Published: December 2008

The incidence, predisposing factors, management and outcome of toxic megacolon (TM) has been reviewed in 65 cases of severe ulcerative colitis (UC) and compared in 2 successive 6-year periods before and after January, 1973. Nineteen episodes of TM occurred in 18 patients. Despite a conscious aim towards earlier surgery in recent years this was not achieved, and despite more intensive medical therapy the incidence of TM was unchanged. Emergency operative mortality in UC fell from 36% to 21% but the mortality of TM remained at 30%. The chief cause of death was colonic perforation. Mortality was associated with increased age, longer pre-operative hospital stay and lower levels of serum albumin. These findings reemphasize the need for earlier surgery if TM is to be prevented, but such a policy must result in some unnecessary emergency colectomies.
‘Malignant’ macroscopic appearance of an inflammatory testicular lesion—a reminder for surgeons
Authors: Sternberg A , Mor C , Servadio C , Reiss R
Published: December 2008

Inflammatory changes in the tunica vaginalis testis may assume a misleading appearance which is highly suggestive of malignancy. Obviously, histological examination is crucial for establishing the corrent diagnosis. This phenomenon has been described in texts dealing specifically with testicular pathology, but is not emphasized in standard text books of urology, surgery or pathology. An illustrative case serves as the basis for discussing this entity, for the purpose of familiarizing it to surgeons, urologists and pathologists who are yet unaware of it.
Spontaneous intraperitoneal rupture of the urinary bladder
Authors: Jenkinson Lloyd R
Published: December 2008

Spontaneous rupture of the bladder is a rare occurrence but carries a high mortality. A female case is reported and the mode of presentation, investigation and management discussed.