bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute renal failure due to glomerulonephritis associated with staphylococcal infection
Authors: Maher E. R. , Hamilton D. V. , Thiru S. , Wheatley T.
Published: December 2008

Acute renal failure developed in a diabetic with staphylococcal arthritis and septicaemia in the absence of endocarditis. Renal biopsy showed proliferative glomerulonephritis and there was evidence of alternative pathway of complement activation. Renal function recovered following haemodialysis for 2 months. The association of glomerulonephritis with staphylococcal infection is reviewed.
Carcinoma of the vagina presenting as a ruptured procidentia with an entero-vaginal fistula and prolapse of the small bowel
Authors: Howat J. M. T. , Mohandas I. , Stassan L. , Daw E.
Published: December 2008

A case of a carcinoma of the vagina which presented as a ruptured procidentia with an entero-vaginal fistula and prolapse of the small bowel is reported.
Severe dothiepin intoxication—a report of two cases
Authors: Bloodworth L. , Wilson A. , Collins P. , Rainford D. J.
Published: December 2008

Two patients with severe dothiepin intoxication are described. The management of these cases is discussed and we draw attention to the prolonged elimination half-life of dothiepin and its metabolites, and the implication for treatment.
Gastric emptying after surgery for the dumping syndrome
Authors: Harries A. D. , Dew M. J. , Crawley E. O. , Leach K. G. , Salaman J. R. , Rhodes J.
Published: December 2008

The dumping syndrome following gastric surgery for peptic ulcer disease can cause severe morbidity. In this study the benefit of interposition of an antiperistaltic jejunal loop to reverse peristalsis and delay gastric emptying was assessed in four patients with severe symptoms by performing gastric emptying studies pre-operatively, and at 6 months and 24 months following surgery. Gastric emptying was delayed at 6 months but by 2 years had returned to pre-operative values. Patients' symptoms were improved at 6 months and remained so despite the deterioration in gastric emptying. This surgical procedure is of some value to patients with severe symptoms due to the dumping syndrome.
Hypertrophic pulmonary osteoarthropathy complicating Celestin tube insertion
Authors: Young J. B. , Wilkins W. E.
Published: December 2008

A case is reported in which hypertrophic pulmonary osteoarthropathy (HPOA) developed following the insertion of a Celestin tube for a benign oesophageal stricture. The HPOA resolved completely following removal of the tube. It is believed that the Celestin tube was the major factor causing the HPOA, a complication of Celestin tube insertion not previously reported.
Development of Hodgkin’s disease in the course of liver cirrhosis and impaired monocyte function
Authors: Dan Michael , Hassner Avi , Jedwab Medina , Shibolet Shlomo
Published: December 2008

The monocyte function, as measured by phagocytosis and killing of Candida albicans and Candida pseudotropicalis by peripheral blood monocytes, was found impaired in a patient with cirrhosis of the liver on two separate determinations before the occurrence of bleeding from oesophageal varices. Unexpectedly, Hodgkin’s disease was diagnosed in enlarged abdominal lymph nodes found on the occasion of an emergency portocaval shunt operation.
Severe postural hypotension following home canoe construction from polyester resins
Authors: MacFarlane I. A. , Wilkinson R. , Harrington J. M.
Published: December 2008

On two occasions a 36-year-old man developed severe postural hypotension and neurological signs after working with a polyester resin canoe building kit in an unventilated shed. It is likely that his recurrent illness was caused by styrene intoxication. Postural hypotension secondary to styrene exposure has not previously been reported.
Combined barium meal and cholecystogram—an analysis of 1,444 patients
Authors: Watt P. C. H. , Spence R. A. J. , Campbell R. C. , McGurk J. J. , Whytes D. G. C.
Published: December 2008

Since many dyspeptic patients are still investigated initially by radiology, a policy was initiated whereby all such patients were directly referred for combined simultaneous double-contrast barium meal and cholecystogram. This policy was aimed at reducing patient visits to hospital and increasing diagnostic yield.

The results of 1,444 combined procedures are presented. Of these, 310 (25.5%) had a positive finding on barium meal only; 275 (19%) were positive for cholecystogram only; 117 (8.1%) were positive for both examinations; 742 (51.4%) were negative for both examinations. Of all the patients (427) who had a positive finding on barium meal, 27.4% (117) also had a positive finding on cholecystogram. Of all the patients (392) with a positive cholecystogram, 29.8% (117) also had a positive barium meal. Diagnostic yield rose considerably with patient age.

It was found that simultaneous barium meal and cholecystogram presented no serious technical difficulties. It was concluded that in patients over 40 years old, this policy improved diagnostic yield as many patients had both gall bladder and upper gastrointestinal pathology. In all other patients this policy markedly reduced the number of hospital visits. Combined simultaneous double-contrast barium meal and cholecystogram is therefore recommended for hospitals which used radiology for the first line investigation of dyspepsia. Also, the general principle of examination of both gall bladder and upper gastrointestinal tract is pertinent where other first line investigations are used.
Typhoid perforation of the gut
Authors: Khanna A. K. , Misra M. K.
Published: December 2008

One-hundred consecutive patients with typhoid perforation of the gut admitted in the same surgical unit of the University Hospital have been studied. The cases were diagnosed on the basis of history, clinical examination, exploratory findings, histopathological examination, Widal test and blood culture. Forty-six patients had perforation in the second week of fever. Sixty-one patients presented 48-96 hr after perforation. All the patients were subjected to surgery, 16 under local anesthesia. Mortality rate increased from 25% to 83% as the duration between perforation and operation increased.
Renovascular hypertension associated with bilateral aldosteronoma
Authors: Vircburger M. I. , Prelević Gordana M. , Todorović P. , Bojić P. , Perić Ljiljana A. , Paunković N.
Published: December 2008

The authors present a 35-year-old male patient with renovascular hypertension caused by the stenosis of both renal arteries of the right kidney. Two years after the diagnosis of hypertension was made, an endarterectomy was performed but a successful correction of the upper stenotic artery was not achieved. During the next 2 years the hypertensive disease was uncontrollable with antihypertensive medications and gradually entered into a malignant phase. In addition to the atrophy of the right kidney, an adenoma of the left adrenal gland was revealed (19.75 g) which was operated on. Left adrenalectomy had only a transitory benefit on blood pressure level. Five months later an adenoma of the right adrenal gland was diagnosed and together with the ischaemic right kidney was operated on (right adrenalectomy and nephrectomy) which definitely cured the hypertension.

The chronological sequence of events and the course of the disease in the patient point to the possibility that long-standing hyper-reninaemia, due to renal ischaemia, may cause the development of multiple bilateral adrenocortical adenomas and that secondary aldosteronism may transform into primary.
Galactorrhoea following hypophysectomy in a boy with a prolactinoma
Authors: Dandona P. , Mohiuddin J. , Lindsay K. W.
Published: December 2008

An 18-year-old boy with delayed puberty was found to have a large prolactinoma. Hypophysectomy led to a fall in serum prolactin concentration, although it remained markedly elevated. The introduction of replacement therapy, including testosterone, resulted in painful swelling of the breasts and galactorrhoea. Bromocriptine therapy resulted in a cessation of galactorrhoea and normalization of serum prolactin concentrations. The absence of galactorrhoea in association with an astronomical concentration of prolactin, and its onset in association with diminished prolactin concentrations following hypophysectomy and the introduction of testosterone therapy, indicate that galactorrhoea requires the presence of high prolactin concentrations to act on mature breast tissue. This would account for the rarity of galactorrhoea in prepubertal children with prolactinomas.
Acute oliguric renal failure secondary to lymphomatous infiltration of the kidneys
Authors: Leung A. C. T. , McKean M. , Mactier R. , Dobbie J. W.
Published: December 2008

A case of lymphomatous infiltration of the kidneys presenting as acute oliguric renal failure of unknown cause is described. Renal biopsy was required to establish the diagnosis. Combined chemotherapy (MOPP) produced significant improvement in renal function.
Agranulocytosis during malaria prophylaxis with Maloprim (pyrimethamine and dapsone)
Authors: Booth F. , Barker L. C. , Barton C. J. , Naik R. B.
Published: December 2008

A case of agranulocytosis during malaria prophylaxis with Maloprim (pyrimethamine and dapsone) is described. At the recommended dose of one tablet weekly this is apparently a rare occurrence but highlights one of the hazards in a changing climate of malarial prophylaxis in which the use of Maloprim is increasing.
Exposure to sunlight and vitamin D deficiency in Saudi Arabian women
Authors: Fonseca V. , Tongia R. , el-Hazmi M. , Abu-Aisha H.
Published: December 2008

Plasma 25-hydroxy cholecalciferol (25-OH vitamin D) concentrations were measured in 31 adult Saudi Arabian women who presented with acute minor illness. Patients with chronic diseases, malignancy and overt metabolic bone disease were excluded from this study. The median plasma 25-OH vitamin D concentration was 6 ng/ml (range: 2-18 ng/ml). Only three subjects had a concentration within the normal range (10-55 ng/ml). Plasma 25-OH vitamin D concentrations were significantly lower in subjects living in apartments than in those living in villas or rural areas (P less than 0.02). When direct questioning was used to assess exposure to sunlight, plasma 25-OH vitamin D concentrations were significantly lower in those subjects whose average exposure was less than 30 min daily than those whose exposure was more than 30 min daily (P = 0.002).

Our findings confirm the importance of inadequate exposure to sunlight in the aetiology of vitamin D deficiency. Social customs may contribute to this deficiency in spite of abundant sunshine.

Direct questioning to assess the adequacy of sunlight exposure is an essential part of history taking in cases of suspected vitamin D deficiency.
Prospective measurement of glomerular filtration rate and effective renal plasma flow during treatment of malignant essential hypertension
Authors: Ghose R. R.
Published: December 2008

A longitudinal study of sequential measurement of glomerular filtration rate and effective renal plasma flow was conducted over a 5-year period of antihypertensive drug treatment, in four adult patients admitted to hospital with previously untreated malignant essential hypertension. Treatment produced a substantial and sustained lowering of systemic arterial blood pressure, compared with grossly elevated pretreatment levels. Nevertheless, glomerular filtration rate and effective renal plasma flow remained relatively stable in all four patients, at roughly the same level at which they were admitted. It was concluded that effective therapy for hypertension may not necessarily reverse the vascular changes of arteriolar fibrinoid necrosis, which characterize malignant essential hypertension. Permanent damage to the renal arterioles, and the territory of kidney supplied by these vessels, may be a feature of this condition.
The effect of cimetidine on the maintenance of healing of gastric ulceration
Authors: Kinloch J. D. , Pearson A. J. G. , Woolf I. L. , Young P. H.
Published: December 2008

The rate of endoscopically confirmed gastric ulcer relapse was compared in two groups of patients with newly healed benign gastric ulcers, receiving either cimetidine 400 mg nocte or matching placebo, over a period of 1 year. Six of 24 (25%) patients on cimetidine and 16 of 27 (59%) patients on placebo had endoscopically confirmed relapse. These included two patients in each group with asymptomatic relapses. The difference in the rate of relapse between the two groups was statistically significant (P = 0.01).
Gallstone perforation of the ileum without obstruction
Authors: Shankar S. , Bradley J. W. P. , Parker M.
Published: December 2008

A case of perforated ileum due to an impacted gall stone without associated intestinal obstruction, is reported. The problem in diagnosis and management are discussed.
Gastrins and gastrinomas
Authors: Hansky J.
Published: December 2008

The past 20 years have seen gastrin attain true hormonal status. Its structure has been characterized, it has been synthesized, radioimmunoassays for its measurement in blood and tissues have been developed and its physiology and metabolism elucidated. Of much interest to clinicians has been the association between gastrin and tumours of the pancreas (gastrinomas) and atrophic gastritis. The advent of gastrin measurement has facilitated the diagnosis of gastrinoma and the availability of powerful acid suppressants has altered the therapy of gastrinoma.
Acute pancreatitis and gastric dilatation in a patient with anorexia nervosa
Authors: Backett S A
Published: December 2008

A case is described in which a young woman undergoing treatment for anorexia nervosa developed gastric dilatation and acute pancreatitis.

Two previous reports have described these as complications of anorexia nervosa and in view of this case attention is drawn to a possible association between these conditions. The importance of monitoring the anorectic patient's clinical state during the early phase of treatment is stressed.
Severe haemorrhage from a lumbar artery as a complication of percutaneous renal biopsy
Authors: Jamison M H , Coward R A
Published: December 2008

A patient is described with severe haemorrhage from a lumbar artery following percutaneous renal biopsy. The exact source of haemorrhage in this previously unreported complication proved difficult to locate even at surgical exploration.
Sensorimotor neuropathy with sulphasalazine
Authors: Price T R
Published: December 2008

A case of mixed sensorimotor neuropathy associated with sulphasalazine therapy is reported. This is believed to be unique.
Secondary hypertension accompanying high pressure chronic retention
Authors: Ghose R R , Birks J L
Published: December 2008

Two middle-aged men were referred for control of severe hypertension, presumed to be ‘essential’. Late-onset enuresis, a small palpable bladder, and slight prostatic enlargement were elicited in one patient; history and examination were unremarkable in the other patient, apart from moderate prostatic enlargement. Intravenous urography revealed massive bilateral hydronephrosis with hydroureters in both patients. Surgical relief of retention was associated with post-obstructive diuresis and normalization of blood pressure, although recurrence of hypertension occurred later in one patient. These patients suffered from high pressure chronic retention, a syndrome characterized by impairment of renal function and hypertension. Surgical relief of retention was accompanied by prompt correction of hypertension, and gradual, sustained recovery of renal function.
Isolated renal mucormycosis
Authors: Flood H D , O'Brien A M , Kelly D G
Published: December 2008

Isolated renal mucormycosis is very rare and we describe such a case masquerading as a hypernephroma in a poorly-controlled diabetic.
Retroperitoneal fibrosis with normal intravenous urogram
Authors: Creagh F M , Stone T , Stephenson T P , Lazarus J H
Published: December 2008

A 58 year old male presented with a two week history of low back pain and malaise. The intravenous urogram (IVU) at presentation was normal but within three months he had developed renal failure with bilateral ureteric obstruction on repeat IVU. Primary retroperitoneal fibrosis was confirmed at operation.

This case demonstrates that retroperitoneal fibrosis may progress rapidly to renal failure within a few months of the first symptoms. In addition, the IVU may be normal in the early stages of the illness.
Clinical evaluation of the Infrasonde D4000 blood pressure monitor
Authors: Zezulka A V , Sloan P J M , Davies P , Beevers D G
Published: December 2008

Choosing a blood pressure machine from their ever increasing number is often difficult due to lack of performance data. We have evaluated a new automated non-invasive blood pressure recorder, the Infrasonde D4000®. In comparison with the Hawksley random zero mercury sphygmomanometer the Infrasonde showed less variability for both systolic and diastolic readings. However, it was found to record significantly lower mean systolic and diastolic pressures.
Ocular flutter in suspected multiple sclerosis: a presenting paroxysmal manifestation
Authors: Francis D A , Heron J R
Published: December 2008

A patient with suspected multiple sclerosis is described who presented with attacks of blurring of vision and ocular flutter. This has not previously been reported as an isolated paroxysmal manifestation of brain stem demyelination. As with other paroxysmal disturbances ocular flutter may present as the first sign of the disease.
Effect of propranolol on thyroid homeostasis of healthy volunteers
Authors: Wilkins M R , Franklyn J A , Woods K L , Kendall M J
Published: December 2008

The effect of propranolol on thyroid status was investigated by administering the drug in 2 therapeutic doses (80 mg b.d. and 120 mg b.d.) to 8 healthy volunteers and serially measuring total and free thyroid hormones and their major binding protein. Mean free T3 fell by 1.2 pmol/l (P < 0.05) whilst mean free T4 and mean rT3 rose by 3.3 pmol/l (P < 0.01) and 0.16 nmol/l (P < 0.01) respectively. Mean thyroxine binding globulin (TBG) fell by 1.2 mg/l (P < 0.001). Despite the change in free hormone levels there was no significant change in TSH. For the first time the effect of propranolol on circulating thyroid hormones and binding proteins in healthy subjects is apparent within one study. The biological significance of the change in free hormone levels is discussed.
Drug compliance and seizure control in epileptic children
Authors: Lisk D R , Greene S H
Published: December 2008

The drug taking habits and compliance of 16 epileptic children were studied by means of a questionnaire, ‘pill’ count and serum antiepileptic drug levels (AEDL).

The questionnaire method overestimated patients' compliance while, because of the pharmacokinetics of antiepileptic drugs in children, single outpatients' drug levels may be misleading thereby not always reflecting the true degree of compliance.

Ten patients (62%) took more than 85% of their medication. Above this level of compliance there was a positive relationship to seizure control.

It would appear that drug compliance in epileptic children is as unsatisfactory as it is in adults on whom they largely depend for the administration of their medication.
Acute renal failure with polyarteritis nodosa and multiple myeloma
Authors: Williams A J , Newland A C , Marsh F P
Published: December 2008

A patient who presented with acute renal failure due to renal cortical necrosis is described. Renal biopsy showed cortical infarction and angiography demonstrated aneurysms in the renal, splenic and hepatic circulations. Concurrently he was found to have an IgA kappa paraprotein with bone marrow changes diagnostic of multiple myeloma. He was treated with haemodialysis, immunosuppressive drugs and plasma exchange but died 3 months after presentation.
Small bowel capillary dilatation in portal hypertension
Authors: Gallagher C , Bonar F , Dempsey J , Crowe J
Published: December 2008

A patient with small bowel capillary dilatation and cirrhosis is reported. This patient had persistent, unexplained gastrointestinal bleeding. Small bowel capillary dilatation appears to be unique to patients with portal hypertension. The possible role of small bowel capillary dilatation in causing gastrointestinal bleeding is discussed.
Lowered ultraviolet minimal erythema dose in hemiplegia
Authors: Cox N H , Williams S J
Published: December 2008

In view of recent reports of increased tanning in hemiplegic limbs, we have investigated ultraviolet (u.v.) minimal erythema dose (MED) in hemiplegia using the bilateral comparison technique. Seven of 10 patients had a lower MED in the hemiplegic arm compared to the normal side, the mean reduction being 16% (range 0–33%, P = 0.003). No patients had a higher MED in the hemiplegic arm. We review the literature regarding other non-neurological features of hemiplegia, in particular asymmetry of temperature, oedema, and finger clubbing, and we propose a vasomotor or trophic aetiology for these findings.
Subconjunctival haemorrhage: a feature of acute severe asthma
Authors: Rodriguez-Roisin R , Torres A , Agustí A G N , Ussetti P , Agustí-Vidal A
Published: December 2008

Bilateral subconjunctival haemorrhage was observed on 5 separate occasions in 4 patients presenting a fulminant form of acute severe asthma. Four of these episodes required ventilatory support. All patients recovered from their asthma attack after treatment with bronchodilators, corticosteroids, and oxygen. The incidence of this previously unreported finding represents 5% of the total number of patients with acute severe asthma mechanically ventilated in our intensive care unit from 1976.
Malignant inflammatory fibrous histiocytoma of bone and acute lymphoblastic leukaemia
Authors: Woodcock B E , Parsons M A , Winfield D A
Published: December 2008

A patient is described who developed a malignant inflammatory fibrous histiocytoma of vertebral bone (MFH) 4 months after the onset of acute lymphoblastic leukaemia. This is the first report of the simultaneous occurrence of these two conditions. Similarities to the more frequent occurrence of another histiocytic malignancy, histiocytic medullary reticulosis, following acute lymphoblastic leukaemia, are noted. The usefulness of gallium scanning to monitor the response of this tumour to treatment is demonstrated.
Spontaneous perforation of a pyometra presenting as generalized peritonitis
Authors: Hosking S W
Published: December 2008

Eleven cases of spontaneous perforation of a pyometra have previously been reported. All were associated with, and probably secondary to, cervical occlusion. A further case is described, but differs in that the cervical canal was patent. In the absence of other possible causes of uterine perforation, the aetiology of the perforation in this case remains uncertain.
Non-invasive assessment of early cardiac involvement in systemic sclerosis
Authors: Butrous G S , Dowd P M , Milne J , Dymond D S , Caplin J , Camm A J
Published: December 2008

Twenty-eight patients with wide spectrum organ involvement of progressive systemic sclerosis but without signs or symptoms suggestive of cardiac involvement were studied by non-invasive cardiac techniques. The 12-lead electrocardiogram showed abnormalities in 6 patients: one had abnormal T waves and 5 had complete or incomplete right bundle branch block. Twenty-four hour ambulatory electrocardiography demonstrated higher average heart rates than in similar aged controls (82 +/- 9 vs 74 +/- 9 beats/min, P less than 0.05). In one patient a short run of ventricular tachycardia was recorded. No other significant arrhythmia was documented. Echocardiographic measurements were within normal ranges but small pericardial effusions were observed in two patients (7%). Resting first pass radionuclide angiography, utilizing 12 mCi of technetium 99m were performed in 23 patients. Seven patients (30%) had abnormal wall motion (diffuse hypokinesia), with a significant decrease in ejection fraction in comparison to those with normal wall motion (44 +/- 6% vs 60 +/- 6% P less than 0.01). Those with abnormal wall motion had suffered the disease longer than those with normal wall motion (13 +/- 4 vs 9.5 +/- 7 y). In conclusion, the heart is involved in half of the patients in this series; non-invasive cardiac assessment is useful in disclosing the early cardiac involvement and may influence long-term management.
The clinical value of Haemoccult and Fecatwin in the detection of colorectal neoplasia in hospital and general practice patients
Authors: Barrison I G , Parkins R A
Published: December 2008

Four hundred and fifty asymptomatic general practice patients and 330 hospital inpatients had their stools tested for occult blood with the Haemoccult and Fecatwin methods.

In general practice, 9/64 (14%) of patients with a positive result had a colonic neoplasm (three carcinomas, one Dukes' Stage A, two Dukes' Stage C, six adenomas) and in hospital 12/142 patients (8%) were found to have colonic tumours, (nine carcinomas, two Dukes' Stage A, two Dukes' Stage B, five Dukes' Stage C and three adenomas). The overall detection rates for colonic neoplasia were 2% in general practice and 3.4% in hospital. In 2 years of follow-up, none of the general practice patients have presented with colonic symptoms. Two hospital patients with colonic carcinomas produced negative tests with both methods.

Out of the total of 21 colonic neoplasms, nine were detected by Fecatwin alone, but this trend in favour of the more sensitive test did not reach the 5% level of statistical significance. In contrast, the number of false positive results were significantly greater with Fecatwin than Haemoccult.

From our data it would appear that the Fecatwin method warrants assessment in a full controlled trial of its value as a population screening test for colonic cancer.
Pseudo-phaeochromocytoma due to alcohol withdrawal
Authors: Potter J F , Beevers D G
Published: December 2008

Alcohol withdrawal hypertension is a common clinical problem which often goes unrecognized. We report a case in which the symptoms and signs of withdrawal with a marked elevation in blood pressure mimicked the features of a phaeochromocytoma. Despite a positive phentolamine test no further evidence for phaeochromocytoma was found and both blood pressure and symptoms settled as the features of alcohol withdrawal abated.
Anti-arthritic propionic acid derivatives and 17-oxosteroid measurements—a direct interference
Authors: Ng L L , Chalmers T M , McLeish R L , Raggatt P R
Published: December 2008

Many drugs interfere with the assay of urinary 17-oxo and oxogenic steroids. Some propionic acid derivatives, in particular, tiaprofenic acid, have now been shown to affect this assay. Care should be taken when interpreting results in patients on these drugs.
Primary nongestational choriocarcinoma of the ovary
Authors: Raju G C , Woo J , Marchack D , Naraynsingh V
Published: December 2008

Primary choriocarcinoma of the ovary arising, presumably, from a germ cell is extremely rare. The patient, a 16 year old girl who presented with dysuria and frequency of micturition developed fatal haemoperitoneum due to rupture of a pure primary nongestational ovarian choriocarcinoma.
Hepatic necrosis with doxapram hydrochloride
Authors: Fancourt G J , Ashton R J , Talbot I C , Wales J M
Published: December 2008

We report the first case of acute hepatic necrosis, which we believe to have been caused by the administration of the respiratory stimulant, doxapram hydrochloride (Dopram).
Chronic airflow limitation after inhalation of overheated cooking oil fumes
Authors: Simpson F G , Belfield P W , Cooke N J
Published: December 2008

A patient who developed severe irreversible airways obstruction with features of bronchiolitis obliterans after exposure to fumes from overheated cooking oil is described.
Alpha and beta cell evaluation in patients with thalassaemia intermedia and iron overload
Authors: De Sanctis V , Gamberini M R , Borgatti L , Atti G , Vullo C , Bagni B
Published: December 2008

Insulin and glucagon secretion were studied during an oral glucose tolerance test and arginine infusion in 11 patients with thalassaemia intermedia, who showed laboratory evidence of iron overload. Mean blood glucose concentrations in patients with thalassaemia intermedia were significantly higher than normal and 3 of 11 patients had impaired glucose tolerance. The principal abnormality appears to be a deficiency in insulin and glucagon from the pancreas in response to oral glucose tolerance and arginine stimulation tests. Several factors, such as iron overload, chronic hypoxia, zinc deficiency and increased catecholamine production secondary to anaemia, might play a part in the pathogenesis of these abnormalities. Each of these factors affect individual cases to a varied degree. Our data emphasize the mildness of carbohydrate defect as compared to the degree of insulinopenia and indicate the necessity for prescribing measures which prevent excessive iron deposition and improve iron excretion in thalassaemic patients with iron overload.
How often can an embolic stroke be diagnosed clinically? A clinicopathological correlation
Authors: Humphrey P R D , Harrison M J G
Published: December 2008

A retrospective case note survey of 103 autopsy proven cases of cerebral infarction was carried out to assess how often a cardiac source for embolism had been correctly suspected on clinical grounds. Only 61% of 46 patients with cardiac embolic sources were so identified. Cases of rheumatic heart disease and bacterial endocarditis were more frequently identified than cases of mural thromboembolism from ischaemic heart disease. This relative failure of unaided clinical diagnostic criteria probably accounts for the discrepancy between the autopsy evidence of cardiac embolism as a cause of stroke (about 40%), and clinical studies (about 20%).
Small bowel stricture following abdominal trauma
Authors: Welch G H , Anderson J R
Published: December 2008

A case of small bowel stricture developing 2 months after blunt abdominal trauma from a lap seat belt is presented. The cause of the stricture was probably a small perforation sustained at the time of the injury but overlooked clinically. At operation an abscess around the terminal ileum was found. The patient made an uneventful recovery following resection of the strictured small bowel.
Cytomegalovirus and inflammatory bowel disease
Authors: Morton R
Published: December 2008

An 80 year old man was admitted to hospital with a 4 month history of diarrhoea with blood and mucus. The diarrhoea could not be controlled by a variety of drugs and he died 7 weeks later. Rectal biopsy showed both intranuclear and intracytoplasmic inclusional bodies consistent with cytomegalovirus infection.
Incidence of dilated cardiomyopathy
Authors: Abelmann Walter H
Published: December 2008

Full reliable data on the incidence and prevalence of dilated cardiomyopathy are not available. In the United States, at least 0.7% of cardiac deaths are attributable to cardiomyopathy. Dilated cardiomyopathy probably contributes the great majority of these cases. The mortality rate for cardiomyopathy in males is twice that of females, and for blacks it is 2.4 times that of whites. Cardiomyopathy was diagnosed in 0.67% of patients discharged from hospitals in 1979 with diagnoses of disease of the circulatory system. Cardiomyopathy accounted for 1% of general cardiologists' and for 7% of academic cardiologists' patient encounters.

In Scandinavia, population surveys suggested an annual incidence of dilated cardiomyopathy ranging from 0.73 to 7.5 cases per 100,000 population; for Tokyo this figure is 2.6. The prevalence of cardiomyopathy in underdeveloped and in tropical countries is considerably higher than in developed countries.
Viral myocarditis and dilated cardiomyopathy — an experimental study with special reference to immunological behaviour of T- and B-lymphocytes
Authors: Kawai Chuichi , Kishimoto Chiharu
Published: December 2008

The direct transition from acute myocarditis to dilated cardiomyopathy has been demonstrated in an inbred strain of DBA/2 mice inoculated with the M-variant of EMC virus. The severity of myocarditis, which determines the development of congestive heart failure and, later, the diseased state resembling dilated cardiomyopathy, seems to be mediated by T-lymphocytes.
Behçet's disease presenting as benign intracranial hypertension
Authors: Wilkins M R , Gove R I , Roberts S D , Kendall M J
Published: December 2008

Two siblings with Behçet's disease presenting as benign intracranial hypertension are reported and the literature is reviewed. We suggest that raised intracranial pressure should be added to the clinical criteria considered for the diagnosis of Behçet's disease.
An unusual volvulus—the ileosigmoid knot
Authors: Johnson C D
Published: December 2008

A case is presented of an ileosigmoid knot in a 70 year old man. A strangulated loop of ileum was wrapped around the neck of a sigmoid volvulus. Following small bowel resection and sigmoid colectomy with colostomy, the patient made an uneventful recovery.
Diclofenac-induced hepatotoxicity
Authors: Schapira D , Bassan L , Nahir A M , Scharf Y
Published: December 2008

Two patients developed clinical, biochemical and histopathological signs of a liver hypersensitivity reaction following treatment with diclofenac. Hepatic side effects of this drug are very rare. The relevant literature is reviewed.
Metastatic follicular carcinoma of the thyroid presenting with thyrotoxic induced impaired control of diabetes mellitus
Authors: Samanta A , Burden A C , Jones G R , Nicol N T
Published: December 2008

We report a patient with pulmonary and bony metastases due to follicular carcinoma of the thyroid, occurring 12 years after the initial diagnosis. This was brought to light by worsening diabetic control due to thyrotoxicosis from functioning malignant thyroid tissue. Following radio-active iodine therapy, she remains well with good control of her diabetes.
Intramural pseudodiverticulosis—an unusual cause of benign oesophageal stricture
Authors: Stephens W P , Mossman A , Ratcliffe J F , Gould D A , Oleesky S
Published: December 2008

Three cases of intramural pseudodiverticulosis of the oesophagus are described together with a review of the relevant literature. This unusual condition, diagnosed by characteristic features on the barium swallow, is associated with a high incidence of benign oesophageal stricture which responds readily to endoscopic dilatation.
Renal vein thrombosis with recurrent pulmonary emboli in the nephrotic syndrome: use of the Greenfield filter
Authors: O'Brien A A , O'Donnell J P , Keogh J A B
Published: December 2008

We describe a case of renal vein thrombosis in association with the nephrotic syndrome. The patient had recurrent pulmonary emboli which, having failed to respond to routine anticoagulant treatment, were managed successfully by the insertion of a Greenfield filter into the inferior vena cava above the renal vein thrombosis site. The only coagulation abnormality in this patient was a deficiency of antithrombin III.
Fatal pneumococcal septicaemia in coeliac disease
Authors: O'Donoghue D J
Published: December 2008

A case of overwhelming pneumococcal septicaemia in a 34 year old man with coeliac disease and hyposplenism is reported. This previously unrecorded complication was fatal despite prompt treatment.
The relationship of arrhythmias to walking activity during mobilization after myocardial infarction
Authors: Roland J M , Banks D C , Edwards B , Fentem P H
Published: December 2008

The extent to which everyday walking activity is responsible for ventricular arrhythmias in the first 6 weeks after suspected myocardial infarction has been studied by simultaneous 24-hour recordings of electrocardiogram and walking activity. Forty-eight recordings from 46 patients were identified which contained couplets, ventricular tachycardia or R-on-T extrasystoles. In 24 recordings (50%) all the arrhythmias occurred whilst the patient was at rest and in a further four recordings there were fewer arrhythmias during activity than would have been expected by chance. Nineteen recordings (40%) contained arrhythmias which may have been induced by activity but in only three of these was the relationship definite. Clear evidence of arrhythmias precipitated by walking was found in only a minority of patients mobilizing after suspected myocardial infarction.
Male fertility in Crohn's disease
Authors: Burnell D , Mayberry J , Calcraft B J , Morris J S , Rhodes J
Published: December 2008

The fertility of 70 men with Crohn's disease and a group of age matched controls were compared. Crohn's disease was associated with a significant reduction in family size independent of steroid or sulphasalazine treatment.
Generalized muscular pseudohypertrophy in cysticercosis
Authors: Chopra J S , Nand N , Jain K , Mittal R , Abrol L
Published: December 2008

A 32 year old male Hindu, presenting with generalized muscular hypertrophy (Veritable Hercules), together with subcutaneous nodules and epilepsy, due to cysticercosis is described.
Crohn's disease—is there a long latent period?
Authors: Reilly R P , Robinson T J
Published: December 2008

Four cases of Crohn's disease developing in adult females, who had been in close contact during their teens, are described. It is suggested that this could indicate an infective causation for Crohn's disease with a long latency.
Tuberculosis and renal transplantation—observations from an endemic area of tuberculosis
Authors: Malhotra K K , Dash S C , Dhawan I K , Bhuyan U N , Gupta A
Published: December 2008

Ninety-five renal transplant recipients from an endemic area of tuberculosis were investigated to find out the prevalence and course of tuberculosis in pre- and post-transplant periods. Eleven patients had tuberculosis in the pre-transplant period - pulmonary (2), pleural (2), miliary (1), abdominal (2), lymph node (5) and pericardial (1). They were transplanted after antituberculous therapy of 3 to 6 months with satisfactory results. The anti-tuberculous treatment was usually continued for 2 years. Only one of the above 11 patients had evidence of tuberculosis in the post-transplant period. Nine patients developed tuberculosis for the first time in the post-transplant period - pulmonary (4), pleural (1), miliary (1), lymph node (4) and pericardial (1). There was no mortality due to tuberculosis. Thorough search for tuberculosis is mandatory both during pre-transplant assessment and post-transplant follow-up in areas of endemic tuberculosis.
Pulmonary infection with opportunist mycobacteria on Merseyside 1974–1983
Authors: Clague H W , El-Ansary E H , Hopkins C A , Roberts C
Published: December 2008

During a 10 year period 49 patients were recorded as having pulmonary infection caused by opportunist mycobacteria. Six different species were identified of which M. kansasii (65%) and M. avium-intracellulare (20%) were the most common. Cough and sputum (82%) or haemoptysis (26%) were frequent symptoms on presentation and over two thirds of patients had pre-existing respiratory disease. Chest radiographs showed predominantly apical disease with the right apex (44%) being twice as commonly affected as the left (22%). In 30% the radiograph showed bilateral disease.

Clinicians had an individual approach to treatment with no uniform pattern of drug prescribing. A majority of patients (59%) received rifampicin for at least 9 months and those patients with M. kansasii infection responded well with no bacteriological relapses in 20 patients followed for a mean period of 3.9 years. M. avium-intracellulare, M. malmoense and M. xenopi were less responsive to treatment and in four patients receiving chemotherapy death was attributed to mycobacterial infection.
‘Spontaneous’ rupture of the diaphragm
Authors: McIndoe G A J , Hopkins N F G
Published: December 2008

A case of ‘spontaneous’ rupture of the diaphragm with herniation and strangulation of the stomach is reported. The diagnosis was made by endoscopy and repair achieved via laparotomy. The patient has made a full recovery.
Chronic granulomatous disease presenting as an oculomucocutaneous syndrome mimicking Behçet's syndrome
Authors: Kelleher D , Bloomfield F J , Lenehan T , Griffin M , Feighery C , McCann S R
Published: December 2008

A female patient who presented for the first time at the age of 19 with oculomucocutaneous syndrome was found to have an absolute deficiency of neutrophil peroxide production. Neutrophil peroxide production as measured by chemiluminescence was zero on stimulation with opsonized zymosan. Direct membrane stimulation with FMLP and calcium ionophore also failed to elicit peroxide production. The diagnosis of chronic granulomatous disease should be considered in young patients with oculomucocutaneous syndrome.
Reversible agranulocytosis due to meprobamate
Authors: Ward S , Meecham J
Published: December 2008

A 52 year old man admitted to hospital in a toxic state, was found to have agranulocytosis, which recovered when an analgesic containing meprobamate was stopped. The patient was known to have had similar symptoms 9 months previously when the drug was first used, thereby demonstrating an idiosyncratic reaction to meprobamate.
Muscle dynamics in hypertrophic cardiomyopathy
Authors: Alvares R F , Goodwin J F
Published: December 2008

Previous reports have demonstrated that patients with hypertrophic cardiomyopathy (HCM) have prolonged isovolumic relaxation period (IRP) reflecting reduced rate of fall of left ventricular pressure. Eighty four patients with proven hypertrophic cardiomyopathy and 31 normal subjects were studied by simultaneous recordings of echocardiogram, apexcardiogram, phonocardiogram and ECG.

In normal subjects the IRP value was 61 ± 11 ms (mean ± s.d.). In the 84 patients there was enormous variability of the IRP value from 0 to 160 ms reflecting abnormal and incoordinate (but not necessarily impaired) relaxation and it was possible to identify three subgroups among the patients: 60 patients in sinus rhythm who had prolonged IRP and significantly above the normal values, 9 patients in atrial fibrillation in whom the IRP was within the normal range and 15 patients with IRP values between 0–45 ms, with the mean (26 ms) below the normal range (mean ± 2 s.d.). This group of patients with short IRP also had signs of outflow tract systolic pressure gradient, with partial mid-systolic closure of the aortic valve, systolic anterior motion of the anterior mitral valve leaflet and paradoxical splitting of the second heart sound. It is suggested that the short IRP is due to extremely delayed aortic valve closure and careful scrutiny of this subset with haemodynamic evaluation has shown that this non-invasive interval (A2-Mo) may not always be a valid measure of left ventricular relaxation.
Asymmetric apical hypertrophy: ten years experience
Authors: Sakamoto T , Amano K , Hada Y , Tei C , Takenaka K , Hasegawa I , Takahashi T
Published: December 2008

This paper reports 10 years experience of 31 patients with asymmetric apical hypertrophy, in whom left ventricular hypertrophy involved the apex exclusively and giant T wave inversion in the left precordial leads was the characteristic finding. This type of hypertrophic cardiomyopathy was observed predominantly in men over 40 years of age. Family history was negative and patients usually had no complaints. Left ventricular hypertrophy was evident by physical examination as in other forms of hypertrophic cardiomyopathy, but a systolic murmur was faint or absent and the second heart sound was frequently split. Electrocardiographic signs may fluctuate, and occasionally progression or regression occurs. Echocardiography including the two-dimensional method was essential for the diagnosis and left ventriculography was helpful for confirmation. To date complications have been infrequent and the prognosis seems good. The relation of asymmetric apical hypertrophy to other forms of hypertrophic cardiomyopathy is under investigation.
Vasodilator therapy of dilated cardiomyopathy
Authors: Cohn J N
Published: December 2008

Vasoconstriction increases impedance to ventricular ejection and impairs the performance of the dilated myopathic heart. Vasodilator drug therapy by reducing vascular resistance, increasing vascular compliance and increasing vascular capacitance improves cardiac function and relieves the signs and symptoms of congestive heart failure. Earlier intervention in an attempt to alter the natural history of cardiomyopathy should be studied.
Pituitary apoplexy and haemorrhage into adenomas
Authors: Tsitsopoulos P , Andrew J , Harrison M J G
Published: December 2008

A review of 78 cases of surgically managed pituitary adenomas revealed that haemorrhage had occurred in 13. Frank haemorrhage or haemorrhagic infarction caused increasing headache, drowsiness, diplopia and visual failure. The correct diagnosis was suggested by skull X-rays and contrast studies leading to prompt surgical decompression.
Trends in psychotropic prescribing in general practice and general medical patients
Authors: Smith A R , McIntosh M , McInnes G T , Lawson D H
Published: December 2008

Psychotropic drug prescribing in 1280 medical inpatients between 1973–75 was compared with that in 1200 similar patients during 1982–83. Three benzodiazepines accounted for 64% of prescriptions in 1973–75 and nine benzodiazepines for 82% of prescriptions in 1982–83. Over the decade, use of psychotropic drugs fell from 56% to 38% (P < 0.001), primarily due to a reduction in patients treated only in hospital (34% vs 16%, P < 0.001). Before admission, the proportions of patients receiving these drugs were similar (17% vs 18%). During admission, concomitant administration of similar drugs declined from 22% of patients in 1973–75 to 11% in 1982–83 (P < 0.001), while concurrent prescribing before admission increased from 13 to 19%. The marked fall in psychotropic drug use and in inappropriate concomitant therapy indicates an encouraging trend towards more rational drug use at least in hospital. This was achieved without fiscal control and further rationalization of prescribing habits may be achieved by self-audit within the profession without legislative action.
Iodine-induced hyperthyroidism in a patient with a normal thyroid gland
Authors: Shilo S , Hirsch H J
Published: December 2008

Iodine-induced hyperthyroidism can develop even in the presence of an otherwise normal gland. One of the less common sources of iodine is tablets of seaweed, sold over the counter without prescription. We report the case of a 72 year old female who developed clinical and laboratory evidence of hyperthyroidism while ingesting sea-kelp (Vitalia) tablets. Six months after stopping the tablets, the symptoms and laboratory evidence of hyperthyroidism had disappeared. No evidence of pre-existing thyroid disease was found.
Gait ataxia as a presenting symptom of malignant epidural spinal cord compression
Authors: Karp S J , Ho R T K
Published: December 2008

A 68 year old man with prostatic carcinoma developed spinal cord compression. The sole presenting feature was painless gait ataxia indistinguishable from cerebellar ataxia. He was investigated for cerebellar disease but the correct diagnosis was made when he subsequently presented with paraplegia and classical signs of spinal cord compression. Surgical decompression failed to produce neurological recovery.

We discuss the importance of recognizing this unusual presentation of spinal cord compression, its possible mechanism and evidence that it may be under-reported.
Anticholinergic-induced analgesia: possible role for the cholinergic system in abnormal sensory symptoms in Parkinson's disease
Authors: Sandyk R
Published: December 2008

Sensory symptoms related to pain perception have been reported to occur in 30–50% of parkinsonian patients. Two patients with Parkinson's disease are reported, in whom painful sensory phenomena preceded or accompanied the disease process. In both patients the sensory phenomena were unresponsive to therapy with oral narcotics, anti-inflammatory drugs or administration of levodopa/carbidopa. Benzhexol (4-6 mg/day) produced dramatic amelioration of symptoms, indicating a role for the cholinergic system in the pathophysiology of abnormal sensory symptoms in Parkinson's disease and possibly in human analgesia in general.