bluuebunny/crossref_metadata_2025 huggingface dataset:
Calcitonin
Authors: Foster G V
Published: December 2008

In 1962 Copp proposed the existence of a hypocalcaemic hormone. Subsequent studies have shown him to be right.

Calcitonin is a potent inhibitor of bone resorption. By its action it lowers systemic blood calcium. It is secreted in response to hypercalcaemia by a distinct endocrine system within the thyroid in mammals and within the ultimobranchial bodies in fish, amphibia and reptiles. The active principle from pig has now been isolated and found to be a polypeptide composed of thirty-two amino acid residues. Together with parathyroid hormone, the hormone provides precise regulation of calcium concentration in the blood and controls bone remodelling and mineral turnover. Calcitonin in man may be secreted in excessive amounts by medullary carcinoma of the thyroid. In addition, aberrations in its secretion may play a role in pseudohyper-parathyroidism and ostepetrosis.
Autoimmune haemolytic anaemia complicating methyldopa therapy
Authors: Surveyor Ivor , Saunders K C , Evans Byron , Parry T E
Published: December 2008

Ten out of fifty-seven patients on methyldopa therapy were found to have a positive direct Coombs’ test, the antibody being in all cases of the IgG type. Four of these had an autoimmune haemolytic anaemia and in spite of associated diseases all four showed rapid haematological improvement when the drug was stopped.

The incidence of autoimmune haemolytic anaemia due to methyldopa may be higher than has previously been suggested, but since the haemolytic process is reversible it seems reasonable at present, in view of its effectiveness as a hypotensive drug, to continue its use under adequate haematological control.
Sickle-cell disease in pregnant immigrants
Authors: Buckle A E R
Published: December 2008

Thirteen pregnancies in nine patients with sickle-cell disease, sickle-cell/haemoglobin C disease and sickle-cell/thalassaemia are reported. There was one maternal death and one stillbirth. Crises occurred in three of the four patients with sickle-cell disease but in only one of the three patients with sickle-cell/haemoglobin C disease.
The Westminster Hospital coronary unit—experience with 260 patients admitted consecutively with a diagnosis of acute myocardial infarction
Authors: Thurston J G B
Published: December 2008

In successive years since the opening of a Coronary Care Unit at Westminster Hospital the mortality has been 26 and 20% and for the first 4 months of 1968, 5·3%. Overall mortality for 260 patients was 20%.

Resuscitation has been successful in 59% of cardiac arrests within the unit and in 27% of those outside the unit caused by myocardial infarction. Seventeen patients left hospital alive and well who presumably would not have survived had they been treated at home.

Given efficient nursing staff and a resuscitation team, there can no longer be any justification for the treatment of patients with myocardial infarction anywhere other than in a coronary care unit, where such facilities are made available, providing admission is arranged within 3 days of the infarcting episode. The disadvantage of an ambulance journey to a patient with a recent infarct after this period of time may outweigh the advantage incurred by the coronary care unit.

The Peel Coronary Prognostic Index remains a very useful guide to prognosis in spite of this author’s attempts to demonstrate any inaccuracies in its predictions.

A high (20%) ‘misdiagnosis’ rate must be accepted if some patients with bona fide myocardial infarction are not to be excluded from the unit.

The occurrence of 435 deaths reported to Her Majesty’s Coroner for Westminster in the relevant period due to myocardial infarction suggests that the time may be ripe for a ‘flying squad’ resuscitation service in London.
Non-rheumatic mitral incompetence and papillary muscle dysfunction
Authors: Zoob Max
Published: December 2008

Non-rheumatic mitral incompetence may be caused by a variety of conditions affecting the relationships between the papillary muscles, chordae tendineae and mitral valve cusps. Among the commonest of these conditions are ventricular dilatation, ischaemia, congenital and familial abnormalities, senile atrophy of the muscles and spontaneous rupture. There is a very wide range of severity of the resultant clinical syndromes. Some patients are asymptomatic, others are moderately or severely incapacitated, while the severest cases may have acute pulmonary oedema which may be rapidly fatal. The diagnosis is strongly suggested by a late systolic murmur which may be initiated by a mid-systolic click while in others there is the unusual combination of an ejection-type systolic murmur with a quick-rising pulse. The diagnosis can be conclusively established by cineangiography and severe cases can be greatly helped by replacement of the mitral valve with a prosthesis.
Tissue hypoxia and metabolic acidosis—significant factors?
Authors: Stewart J S S
Published: December 2008

In very rare cases severe metabolic acidosis may cause hypotension, respiratory depression and cardiac arrest. Although rare this cause of shock is important because correction of the metabolic acidosis may be life-saving.

Mild metabolic acidosis is relatively common in cases of hypoxia and shock, and is an index of the severity of these. Recurrent metabolic acidosis, which reflects failure of the therapy to control the cause of the acidosis, is a gloomy prognostic sign.
Coagulation disturbances in shock
Authors: Lasch H G
Published: December 2008

Hypocirculation causes hypercoagulability with an increase of Factors V and VIII, and a diminished platelet count. In shock hypercoagulability is followed by hypocoagulability due to loss of Factors I, II, V, VIII and XIII together with thrombocytopaenia and qualitative alterations in platelet properties. This reversal is caused by disseminated intravascular coagulation consuming clotting factors and platelets—consumptive coagulopathy.

Fibrin deposits occur in the peripheral vasculature of the viscera and are associated with a rising oxygen debt, and, in clinical situations, with haemorrhagic diathesis, visceral necrosis and irreversible shock. Localization of the microthrombi is under the influence of catecholamines, ACTH and aldosterone.

Administration of heparin in clinical shock may prevent the development of consumptive coagulopathy, but is without effect if disseminated intravascular coagulation is already present.

Anti-fibrinolytic therapy is contraindicated whereas streptokinase-induced fibrinolysis has experimental and clinical justifications.
The insulin response to glucose in patients with pancreatic disease
Authors: McKiddie M T , McBain G C , Buchanan K D , Bell G
Published: December 2008

The insulin response to glucose was studied in twenty-five patients with pancreatic disease, of whom twelve had chronic pancreatitis, five developed glycosuria following an attack of acute pancreatitis and eight had a carcinoma of the pancreas.

A low insulin response was found in subjects with frank diabetes mellitus but in the majority of those with chronic pancreatitis the insulin response was prolonged and of normal degree. This suggests that glucose intolerance in these patients is not due to simple insulin deficiency but may be due to the release of an abnormal insulin or to insulin antagonists.

All eight patients with carcinoma of the pancreas had a low insulin response to glucose.
Anti-anginal drugs
Authors: Goldbarg Alberto , Paxinos James , Miller Russell R
Published: December 2008

This review of studies on anti-anginal agents and their use in the anginal syndrome shows nitroglycerin to be unsurpassed in clinical effectiveness. It has a rapid onset of action. Its duration of action is relatively short but the need for a more prolonged effect has not been demonstrated. Most anginal attacks subside upon resting and the requirement for relief is immediate rather than prolonged. A long-acting anti-anginal agent would have some value if it could prevent precipitation of an anginal episode but there is no convincing evidence to indicate that these drugs have this capability. In general, clinical experience with long-acting nitrites is relatively unsatisfactory.
A 6-year survey of resistance patterns of urinary tract pathogens in general practice
Authors: Robertson M H
Published: December 2008

A survey of resistance patterns of urinary pathogens causing infections in general practice over the period 1964-69, including 3100 cases of which 2718 were caused by Bacterium coli, Proteus species or coliform organisms has been made. The resistance patterns of the enterobacteria have been examined and reveal a rise in incidence of sulphonamide-resistant strains from 1964 to a peak of 61·3% in 1967 followed by a symmetrical fall to return to 24·9% in 1969. Ampicillin and nalidixic acid were the only two drugs of twelve to show a constant rise in incidence of resistant strains although the figures are much lower reaching peaks of 11·1% in 1969 for ampicillin and 3·2% in 1969 for nalidixic acid. The other drugs surveyed show less definite change; tetracycline constantly shows an incidence of about 30% resistance and nitrofurantoin varies between 2·7% and 8·7%. Low incidences of resistance against trimethoprim-sulphonamide mixture are recorded: 1·5% in 1968 and 2·0% in 1969. Proteus strains, treated separately, frequently show resistance to tetracycline, 90·3% in 1969, and to nitrofurantoin, 37·8% in 1969.

The incidence of multiple resistance is also increasing. Fifty-three percent of strains were resistant to at least one antibiotic and 6% to three or more in the period 1964-67 and 57·3% show resistance to at least one drug and 10·3% to three or more in the period 1967-69.
Presensitization and kidney transplant failures
Authors: Terasaki P I , Kreisler M , Mickey R M
Published: December 2008

Over 1000 kidney transplant patients were tested for cytotoxic antibodies before transplantation.

It was found that patients with preformed antibodies had a significantly poorer outcome than those without antibodies in terms of clinical ranks and survival. This effect was over and above the instances of hyperacute failures previously shown to be associated with preformed cytotoxins.

Among patients who received second transplants from cadaver donors, an extremely high failure-rate was observed in patients who had developed antibodies following the first graft, whereas if antibodies were not present, the failure-rate was comparable with that of first transplants done in patients without antibodies.

By analysis of survival curves using logarithmic plots, it is postulated that pre-immunization has its greatest effect in the early 3-6 month high risk period and magnifies incompatibilities which occur with unrelated cadaver donors.
The relationship between sleep, nutrition and mood: a study of patients with anorexia nervosa
Authors: Crisp A H , Stonehill Edward , Fenton George W
Published: December 2008

An initial observation that insomnia, especially early morning waking, is a feature of anorexia nervosa has been confirmed. A further proposition that the insomnia is more closely related to the nutritional disturbance than to the mood state has also been confirmed using standardized measures of weight, sleep and mood. These findings are discussed in terms of the possible relevance to other illnesses involving weight change in which there is an alteration of sleep patterns.
Electron microscopic observations and speculations on Australia antigen
Authors: Almeida June D
Published: December 2008

The use of the electron microscope has simplified methods of detection of Australia antigen in carriers of serum hepatitis, in patients suffering from the disease and those with persistent hepatitis.

Basic studies on the nature and properties of Australia antigen, using the electron microscope, are described.
Observations of gonadotrophic and ovarian hormone activity during recovery from anorexia nervosa
Authors: Crisp A H , Chen C , MacKinnon P C B , Corker C S
Published: December 2008

Serum gonadotrophins and gonadal steroids were measured in six unmarried female patients with anorexia nervosa before and during treatment by feeding and psychotherapy, which led to restoration of weight to matched population mean levels. In three patients whose premorbid weight was normal, hormonal levels during treatment were initially low, but as weight was regained gonadotrophic levels increased and one patient showed cyclical activity. In three other patients who were premorbidly obese gonodotrophic levels did not appear to increase over the period of investigation. With the exception of one patient whose menstrual cycles were resumed during the period of investigation, gonadal steroid levels in general appeared to remain low although, subsequently, regular monthly menstrual bleeding occurred in some of these patients.
The definition of acute respiratory illnesses in children
Authors: Court S D M
Published: December 2008

No generally accepted clinical classification of acute infective respiratory illness in children exists.

In this survey the clinicians accepted in advance an agreed classification using traditional categories based on the part of the respiratory tract most severely affected. The standardized recording of individual symptoms provided a measure of their frequency in each category and made possible a simple quantitative revision of the initial subjective classification.

We believe this classification could help family doctors and paediatricians, provide a sharper tool for epidemiological studies in home and hospital, and improve communication between those studying these disorders in different communities.
Periodic synoviosis (intermittent hydrarthrosis) with observations and studies on a patient
Authors: Reimann Hobart A
Published: December 2008

More than 200 instances of periodic synoviosis have been recorded. It is related to periodic oedema (hereditary angioedema). Various autonomic disturbances accompany episodes. Confusion with rheumatoid arthritis persists. Theoretically an inherent rhythm or feedback mechanism operates as the cause.

The disorder in several observed patients has persisted for decades, worsened or abated. In one instance, contraceptive medication failed to suppress episodes in contrast to the effect of pregnancy in some patients. E-aminocaproic acid disturbed the rhythm and gave mild relief. A few episodes were suppressed after two surgical operations. The inhibitor of Cl esterase in one patient lacked as much as it does in periodic oedema.
The general practitioner
Authors: Venables T L
Published: December 2008

Despite the instruction he receives in medical school, the general practitioner prescribes mainly by trade names. He receives much information, for example advertising and visits from representatives, in which drugs are identified by trade names. Of greatest importance, these at present provide the most convenient and satisfactory method of ensuring that the patient receives a product which will be consistently effective.
Drugs for the treatment of hypercalcaemia
Authors: Paterson C R
Published: December 2008

Hypercalcaemia is ordinarily treated by treatment of the underlying disorder. In some cases, as in malignant disease, in vitamin D poisoning and after a failed parathyroidectomy, the hypercalcaemia itself needs to be treated. A large number of methods have been advocated for this, but phosphate is the drug of choice in most patients. This paper outlines its use, mode of action and side effects and reviews the other methods proposed for the management of hypercalcaemia.
Strictures, rings, webs and spasm
Authors: Edwards D A W
Published: December 2008

The pathology of benign obstructing lesions is presented together with the mechanical problems they create, their radiological appearance, the symptoms which arise from them, and their differential diagnosis by symptoms, based on a study of 230 obstructing lesions.
Carcinoma of the oesophagus and fundus
Authors: Edwards D A W
Published: December 2008

The problems of earlier diagnosis, the diagnostic symptom patterns and radiographic features of carcinoma of the oesophagus and fundus are discussed.
Plasma concentration of nortriptyline as a guide to treatment
Authors: Lyle W H , Brooks P W , Early D F , Leggett W P , Silverman G , Braithwaite R A , Cuthill J M , Goulding R , Pearson I B , Snaith R P , Strang G E
Published: December 2008

Blood samples were collected from forty-five patients with depression who had been taking nortriptyline for at least 14 days. At the time of blood collection the observer recorded his opinion of each patient’s response to treatment either as ‘satisfactory’ or ‘unsatisfactory’, together with any change in therapy then decided upon. The patients came from six different hospitals but all plasma nortriptyline estimations were performed at a single laboratory. No statistically significant correlation could be discerned between dose or plasma nortriptyline concentration and therapeutic response or decision to change treatment. Under the conditions of general psychiatric practice, the occasional ‘spot’ estimation of plasma nortriptyline concentrations is unlikely to be a practical guide to the nortriptyline requirements of most patients.
Penile Parkinsonism
Authors: Osborne M P
Published: December 2008

Priapism following the administration of the tranquillizer pericyazine (Neulactil) is reported. No other aetiology was found after full investigation. The condition resolved during treatment with intravenous benztropine (Cogentin). An attempt has been made to explain the aetiology and rationalize the treatment given.
Pharmacological blockade
Authors: Enderby G E Hale
Published: December 2008

Our technique is essentially one of pharmacological blockade achieved for the most part by a combination of ganglion blocking drug, halothane and β-adrenergic blocker. To these are added the effects of posture and controlled respiration to reduce systolic blood pressure to 60-80 mmHg at heart level. Initially this is seldom difficult, but the maintenance of a steady hypotension often needs an increasing amount of halothane together with a rising end-tidal positive pressure. This paper is restricted to technique, but it would be a mistake not to draw attention to the physiological limitations which this technique imposes. These are the circulatory changes in the brain caused by the steep head-up position and a low systolic pressure, and the altered ventilation: perfusion ratio within the alveoli of the lungs. These are the parameters of physiological trespass within which the technique must be practised if success is to be achieved with safety.
Subarachnoid haemorrhage in pseudoxanthoma elasticum
Authors: Sharma N G K , Beohar P C , Ghosh S K , Gupta P S
Published: December 2008

A case of pseudoxanthoma elasticum presenting with the rare complication of subarachnoid haemorrhage is described.
Treatment of an adrenal cortical carcinoma with a combination of o,p′-DDD and aminoglutethimide
Authors: Scott R D M
Published: December 2008

A patient with Cushing’s syndrome due to an adrenocortical carcinoma is described. Treatment of residual disease and functional metastases was attempted with o,p′-DDD and later aminoglutethimide. Aminoglutethimide in a daily dose of 1 g appeared to have little effect additional to o,p′-DDD. It is important to maintain replacement therapy with cortico-steroids throughout the use of these drugs.
The place of early social assessment in the management of surgical patients
Authors: Bates T , Behr A , Menzies K , Rendall M
Published: December 2008

Twenty-four percent of bed-days were occupied by patients whose discharge from hospital was delayed for social or geriatric reasons in a bed-usage survey carried out on surgical patients during a three-month period of 1973.

By early social assessment with the regular help of a medical social worker it was possible to reduce such delays to 16% in a similar study during the same period of 1974. The at-risk patients were the elderly admitted as an emergency and the present policy contributed particularly to the overall care of this group.
Verapamil in ischaemic heart disease—quantitative assessment by serial multistage treadmill exercise
Authors: Balasubramanian V , Narayanan G R , Khanna P K , Hoon R S
Published: December 2008

The efficacy of verapamil in a dose of 120 mg thrice daily was assessed by an objective protocol. Twenty-five patients with ischaemic heart disease were subjected to serial, measured multistage treadmill exercise without any drugs, and after propranolol 40 mg t.d.s. for 3 days to assess the stress response to beta-blockade. The tests were repeated after 2, 4 and 8 weeks of verapamil. The assessment was based on computerized ST segment changes, the anginal threshold and other objective parameters. Verapamil rendered eight out of thirteen symptomatic patients pain free and significantly increased the anginal threshold in all others. The ischaemic response as assessed by the ST segment changes on exercise showed a marked improvement in the symptomatic as well as the asymptomatic groups. No major side effects were encountered throughout the study. It was concluded that verapamil in a dose of 360 mg/day is an effective antianginal agent free from significant side effects.
Epidemiological impact of recent influenza viruses in various countries
Authors: Delon P J , Assaad F
Published: December 2008

During recent years, although influenza B has given rise to epidemics every 3-5 years, influenza A has caused greater concern to those responsible for the surveillance of the disease. The usual cycle of influenza A waves every 2 or 3 years was modified in many countries by the yearly appearance of new variants of the virus A/Hong Kong/68 (A/England/42/72, A/Port Chalmers/1/73). However, a number of countries, mostly located in Eastern Europe, were not attacked by virus A infections in 1973-74, when the modified variant A/Port Chalmers/1/73 caused a small wave in many areas of the world (this wave occurred in addition to, and often followed, a wave with virus B). Then, in 1974-75, the same countries of Eastern Europe were affected by an epidemic associated with viruses related to A/Port Chalmers, which was generally more widespread in these countries than in those already attacked by this variant the previous year. The epidemiological circumstances which may have led to such differences are not clear, all the more so as these differences were found even in neighbouring countries.

Moreover, the antigenic drift which led from A/England/72 to A/Port Chalmers/73 was of the same magnitude as the previous one which led from A/Hong Kong/68 to A/England/72, but the wave of A/England was much sharper than that of A/Port Chalmers. Also, during the epidemics with A/Hong Kong/68 of influenza year 1971-72, the variant A/Hong Kong/107/71 became fairly widespread. In haemagglutination inhibition tests, A/Hong Kong/107/71 was much more remote from A/Hong Kong/68 than was the subsequent variant A/England/42/72. In spite of this, A/England/42/72 caused vast epidemics the following year whilst A/Hong Kong/71 disappeared.

Although antigenic drifts constitute an element of prediction for patterns of spread of influenza, they are only one of the determining factors which govern the propagation of the viruses. There is at present no clear explanation for the differences in epidemic potential between influenza viruses (as well as for differences in clinical virulence). There is a need for a continuing study of the parameters governing the differences in spread between countries. For this purpose, health administrations should develop further the use of epidemiological indices, the significance of which should be carefully assessed.
Steroids after birth-puberty
Authors: Marshall W A
Published: December 2008

The production of gonadal steroids in the perinatal period may have an important influence on the later development of the hypothalamo-pituitary-gonadal axis. In the prepubertal period there is an increased output of gonadal steroids and of androgens from the adrenal cortex, with a further increase as the secondary sex characters develop. The precise role of individual steroids in the maturation of the reproductive system and of the neuroendocrine regulating mechanisms will probably remain unclear unless conclusions are based on longitudinal studies in which hormone production is related precisely to different parameters of sexual development and somatic growth.
Metastatic endobronchial hypernephroma nine-and-a-half years after nephrectomy
Authors: Khan M Anees , Dulfano Mauricio J
Published: December 2008

A patient with an endobronchial nodular lesion, proved to be clear cell carcinoma (hypernephroma) by fibrebronchoscopic biopsy, is described in which the primary tumour had been resected 9 1/2 years before the onset of the present illness. At post-mortem the remaining kidney was found to be normal.
Abetalipoproteinaemia. A case report with pathological studies
Authors: Yuill G M , Scholz C , Lascelles R G
Published: December 2008

The clinical and pathological features of a case of abetalipoproteinaemia in a 38-year-old patient are described in detail. A feature not previously recorded was a marked reduction in the velocity of ocular horizontal saccadic movements. Pathological studies revealed an active chronic demyelinating process. The patient showed no response to large doses of vitamin E. The rationale for this therapy, and the possible reasons for its failure are discussed.
Spontaneous rupture of the spleen in infectious mononucleosis
Authors: Lee P W R , Whittaker M , Hall T J
Published: December 2008

Two cases of spontaneous rupture of the spleen as a complication of infectious mononucleosis are reported. The literature is briefly reviewed and emphasis placed on the need for awareness of this rare complication.
An appraisal of symptom relief after coronary bypass grafting
Authors: Frick M H
Published: December 2008

Subjective symptomatic improvement is experienced by 90% of patients after coronary bypass surgery. Objective exercise testing reduces this incidence to 70%. An analysis of the multifactorial genesis of pain relief based on data of non-randomized trials reveals that graft patency plays a dominant but not unique role in causing improved symptomatology. In a number of cases, intra-operative myocardial infarctions seem to explain the pain relief but may also have opposite effects. Changes in left ventricular function operate bidirectionally but data on this variable in relation to changes in symptomatology are not amenable for detailed analysis. Progression in native vessel lesions apparently opposes pain relief and has its greatest impact in connection with graft closure. Residual post-operative angina is evidently related also to incomplete revascularization.
Idiopathic cervical and retroperitoneal fibrosis: report of a case treated with steroids
Authors: Husband Peter , Knudsen A
Published: December 2008

Retroperitoneal fibrosis in a 12-year-old boy is reported. This was associated with a fibrotic mass in the neck which resolved spontaneously. Right-sided ureteric obstruction responded to treatment with steroids.
The urinary sodium: potassium ratio and response to diuretics in resistant oedema
Authors: Alexander W D , Branch R A , Levine D F , Hartog M
Published: December 2008

Nineteen patients with severe oedema due to either cirrhosis of the liver or to congestive cardiac failure, who had failed to respond to previous diuretic therapy, were treated with either increasing doses of frusemide (Group A), or with frusemide in a fixed dose of 80 mg daily and increasing doses of spironolactone (Group B). In Group A there was an inverse correlation between the baseline 24-hr urinary sodium: potassium (Na : K) ratio and the 24-hr urinary potassium excretion during diuresis, and a direct correlation between the urinary Na : K ratio before and after diuresis. Thus, in patients of this group during diuresis, there was a significantly higher urinary potassium excretion in those with a baseline urinary Na : K ratio of less than 1, as compared with those with a ratio of greater than 1. In Group B a satisfactory diuresis was achieved without marked urinary potassium loss in those patients with a baseline urinary Na : K ratio of less than 1, whereas no diuresis was obtained in the two patients with a baseline urinary Na : K ratio of greater than 1. These results suggest that the measurement of the baseline urinary Na : K ratio is of help in determining the potential value of spironolactone in patients with resistant oedema.
The differential diagnosis of the short-limbed dwarfs presenting at birth
Authors: Mukherji R N , Moss P D
Published: December 2008

Attention is drawn to the fact that in a number of types of short-limbed dwarfism a precise diagnosis can be made in the neonatal period. Examples are given and the prognostic and genetic implications are discussed. It is important to be able to advise parents of the likely outlook for the infant and of the genetic implication. Early diagnosis is therefore not merely an academic exercise.
Epidemics of haemorrhagic cystitis due to influenza A virus
Authors: Khakpour M , Nik-Akhtar B
Published: December 2008

The present communication describes studies on thirty-three patients with haemorrhagic cystitis. The current epidemic variant of influenza type A virus, A/Tehran/5/75 (H3N2) [antigenically similar to A/Port Chalmers/1/73 (H3N2)], was recovered from the throats of eighteen and the urine of three patients. HI antibody rises to A/Tehran/5/75 virus were detected in over 50% of the cystitis patients tested.
Chronic rhinocerebral phycomycosis in association with diabetes
Authors: Ferstenfeld J E , Cohen S H , Rose H D , Rytel M W
Published: December 2008

Two patients with rhinocerebral phycomycosis associated with diabetes are presented. The chronic nature of the illness in these two cases in emphasized in contrast to the more fulminant course of most previously reported patients. A high index of suspicion is needed to establish the diagnosis as rapidly as possible. Treatment of the underlying disease combined with amphotericin B therapy and radical surgical excision of all infected tissue is important to establish cure of these patients.
Cartilage hair hypoplasia
Authors: Siggers D C , Burke J B , Morris B , Normand I C S , Tanner J M , Williamson D A
Published: December 2008

Six cases of cartilage hair hypoplasia from five kindreds are described. They demonstrate variation in the expression of clinical features such as sparsity of hair, hair calibre, radiological changes, short stature and the extent of the disproportion between sitting height and stature.
Van Buchem disease
Authors: Jacobs P
Published: December 2008

Van Buchem disease is a hereditary sclerosing dysplasia of bone. Both dominant and autosomal recessive modes of transmission have been described. The dominant form tends to be a benign disorder and symptoms are usually confined to those associated with the enlargement of the jaw. The recessive forms tend to have a greater morbidity and symptoms arise from pressure on cranial nerves by hyperostotic bone at the base of the skull. Patients of the dominant families have often had a torus palatinus.

No haematological changes are found. The alkaline phosphatase may be raised—even if the total level is not elevated, the bone fraction may be increased.

The radiological appearances are regarded as characteristic. The jaw is enlarged and thickened to an extent not seen in other bone dysplasias such as osteopetrosis. The cortices of the diaphyses are thickened and the medullary cavities are encroached upon but not obliterated. Abnormal modelling of the bone ends is not found in van Buchem disease. In long bones the distribution is predominantly diaphyseal but the bone ends are also affected.
A comparison of once and twice daily atenolol in hypertension
Authors: Castleden C M , Dathan J R E , George C F
Published: December 2008

The hypertensive action of atenolol has been studied in a randomized double-blind crossover comparison. Twelve patients showed a highly significant reduction in average supine systolic and diastolic blood pressures from pre-treatment values of 196.3/115.9 to 159.1/89.2 mmHg (26.1/15.4 kPa to 22.2/11.9 kPa) after 2 weeks on once daily atenolol. No dose-related reduction in blood pressure was seen and the single 100 mg daily dose was as effective as 100 mg twice daily or 50 mg twice daily. Blood pressures recorded after 2 weeks' atenolol were lower than those obtained at 7 days irrespective of dose.
The effects of potassium supplements, spironolactone of amiloride on the potassium status of patients with heart failure
Authors: Davidson C , Burkinshaw L , Morgan D B
Published: December 2008

Extra potassium supplements, spironolactone or amiloride were given for 5 months to forty-nine patients with heart failure who were taking furosemide and were in a steady state. Plasma potassium increased with all three treatments but there was no significant increase in total body potassium or red cell potassium. These findings together with other studies suggest that patients with heart failure taking diuretics do not have a significant depletion of body potassium.
Amoebic hepatic abscess—potential causes of delay in diagnosis
Authors: Brown R C , McKendrick M W , Grainger K , Paulley J W
Published: December 2008

Delay in diagnosis can be serious in amoebic hepatic abscess, which is readily treatable. Two cases are presented to illustrate potential causes of delay. The first case had never been to an endemic area, apparently contracting the infection from his wife. The second case had negative serological tests.
Primary malignant lymphoma of lung
Authors: Sakula A
Published: December 2008

Primary malignant lymphoma of the lung is a rare variety of lymphosarcoma, to be distinguished from secondary lung involvement in disseminated malignant lymphoma. The condition tends to remain localized to the lung, and lymph nodes are not involved. The prognosis is better than in disseminated malignant lymphoma, and in the case described here a 35-year-old woman was treated by radiotherapy and chemotherapy and survived 20 years.
Pneumopericardium and pneumomediastinum complicating endotracheal intubation
Authors: O'Neill D , Symon D N K
Published: December 2008

Pneumopericardium and pneumomediastinum have been described as complications of endotracheal intubation and assisted ventilation in neonates and children. Here the occurrence of these complications in an adult is described and the possible mechanism discussed.
Epsilon aminocaproic acid (EACA) myopathy
Authors: Lane R J M , McLelland N J , Martin A M , Mastaglia F L
Published: December 2008

Two female patients developed a severe, painful proximal myopathy after taking 18–30 g of epsilon-aminocaproic acid daily for 5 weeks. Marked elevations of serum aminotransferases, creatine kinase and aldolase levels were found and the first patient had electromyographic and muscle biopsy changes of an acute monophasic, necrotising myopathy at the height of the illness. Resolution occurred in both cases on stopping the drug and the second patient had no electromyographic or muscle biopsy abnormalities 3 weeks later. Only 2 recognized cases of the condition have been reported previously but a review of the literature revealed several other possible examples.
Toxic psychosis with antihistamines reversed by physostigmine
Authors: Cowen P J
Published: December 2008

A case of toxic psychosis due to antihistamine poisoning is described. The reversal of this state by physostigmine supports the contention that it is caused by an anticholinergic syndrome. The management of antihistamine poisoning is discussed.
Left ventricular failure with labetalol
Authors: Frais M A , Bayley T J
Published: December 2008

A patient treated for hypertension with labetalol developed left ventricular failure. When the drug was withdrawn and the BP controlled with 2 other agents, the signs of heart failure regressed. The ill effects in this case could have been because the beta-blocking effects of labetalol are 4 to 6 times greater than the alpha-blocking effects. Caution should be exercised when prescribing this drug for patients with heart failure or with previous symptoms.
Promotion of pseudomycelium formation of Candida albicans in culture: a morphological study of the effects of miconazole and ketoconazole
Authors: Borgers M , De Brabander M , Van Den Bossche H , Van Cutsem J
Published: December 2008

The effects of miconazole and its new derivative ketoconazole on Candida albicans have been evaluated by light and electron microscopy.

The growth characteristics and morphology of C. albicans in culture for various periods of time in a solution consisting of Eagle's minimum essential medium supplemented with amino acids and fetal calf serum are emphasized. This medium, normally used for culturing mammalian cells, promotes a rather fast growth of C. albicans and favours the development of pseudomycelium. The obvious interest in using such culture conditions for drug evaluation is the prevalence of pseudomycelium, which in vivo is the predominant pathological form of C. albicans. Suppression of pseudomycelium formation is found in the 10−9 to 10−7m concentration range of the imidazoles. Growth retardation and the destruction of both yeast and pseudomycelial forms brought about by incubating the cells with 10−9 to 10−4m of the drugs are reported. At low doses these changes include the alteration of cell division, an increase in cell volume and a progressive deterioration of subcellular organelles at the cell periphery. At higher doses the involvement of all other organelles is observed finally leading to complete cell necrosis.
The delayed appearance of an antinuclear factor and the diagnosis of systemic lupus erythematosus in glomerulonephritis
Authors: Cairns S A , Acheson E J , Corbett C L , Dosa S , Mallick N P , Lawler W , Williams G
Published: December 2008

In 11 patients who presented with apparently idiopathic glomerular disease the antinuclear factor (ANF) was absent initially but was eventually detected during observation extending over 6 years. In 4 patients a diagnosis of systemic lupus erythematosus (SLE) has now been made and the disease treated. Of the remaining 7, 2 had conditions known to be associated with a positive ANF, and in 4, drug therapy induced the ANF. Clinical features, complement studies and measurement of anti-DNA antibody were of value in distinguishing those patients with SLE from the others.
Seminoma in Marfan's syndrome
Authors: Epenetos A A , Collis C H
Published: December 2008

A patient with a testicular seminoma and Marfan's syndrome is described. The association is unlikely to be by chance alone, and an explanation in terms of either an associated congenital defect, or a minor chromosomal anomaly, is discussed.
Effect of bromocriptine on maturity onset diabetes
Authors: Barnett A H , Chapman C , Gailer K , Hayter C J
Published: December 2008

The effect of the dopamine agonist, bromocriptine, and the dopamine antagonist, metoclopramide, on glucose tolerance was examined in maturity onset diabetics and normal subjects. After bromocriptine there was a lowered fasting blood glucose and improved glucose tolerance in the diabetics. The controls showed an initial improvement in glucose tolerance. A reduction in insulin levels and a marked fall in plasma prolactin was observed in all subjects. Growth hormone concentrations were low and unaffected in the diabetics, and there was an inconsistent rise in the normals. After metoclopramide there was some impairment in glucose tolerance in the normal subjects, but this was not significant in the diabetics. There was also a marked prolactin release in all subjects, but no significant effect on insulin or growth hormone. It is concluded that bromocriptine lowers the blood glucose and improves glucose tolerance in maturity onset diabetics. This action may be the result of the lowered prolactin which occurred without a concomitant rise in growth hormone.
Studies in chronic lymphocytic leukaemia II. Lymphocyte markers, cellular and humoral immunity and the effect of treatment
Authors: Bazerbashi M B , Chanarin I , Denman A M
Published: December 2008

Observations were made on 15 patients with chronic lymphocytic leukaemia, 3 with non-Hodgkin’s lymphoma, and 18 healthy controls. These include characterization of lymphocytes, assessment of humoral and cell-mediated immunity and the effect of treatment. Those responding to therapy showed a disappearance of ‘null’ lymphocytes from the blood with improvement in clinical and haematological parameters. Their immune capacity, however, remained unchanged or continued to deteriorate.
Aplastic anaemia: an analysis of 174 patients
Authors: Mir M A , Geary C G
Published: December 2008

The authors summarize their experience with 174 patients with aplastic anaemia (AA) with particular reference to course, prognostic factors, conversion to other blood disorders, treatment and outcome. Aplastic anaemia was defined as pancytopenia and a hypocellular marrow at some time during the illness. Seven patients terminated with acute leukaemia, 8 developed haematological features of sideroblastic anaemia and 5 showed a red cell membrane defect commonly found in paroxysmal noctural haemoglobinuria.

Complete recovery occurred in only 4 patients; 70 others showed a partial remission with some residual haematological abnormality in peripheral blood. Eighteen of these had spontaneous remission. Remission was brief in 27 patients who died; only 32 patients remained in partial remission. Twenty-five per cent. of the patients with AA run an acute course and die within 6 months of the time of diagnosis. The remainder run a subacute or chronic course, punctuated in some cases by a transient remission, but in others by a conversion to other related haematological disorders. An acute course is suggested by a rapid onset of symptoms, a falling neutrophil count, a haemoglobin level less than 5 g/dl and a very low platelet count. A chronic course is likely in those patients who have a slow onset of symptoms, a stable neutrophil count and a Hb level in excess of 5 g/dl. The authors’ experience shows that the disease runs either of the 2 courses irrespective of the supportive therapy.
T3 toxicosis presented by depression in an elderly woman
Authors: Portnoi V A
Published: December 2008

An elderly patient with thyrotoxicosis complicated by lack of classical clinical signs and normal conventional tests is described. The picture was compounded by development of apathy and depression. This is the second case report of apathetic T3 thyrotoxicosis in the literature. Such a clinical entity can easily be overlooked, but represents one of the treatable disorders of ‘old age depression’.
Lithium toxicity induced by triamterene-hydrochlorothiazide
Authors: Mehta B R , Robinson B H
Published: December 2008

Two patients on long-term lithium therapy for manic-depressive psychosis developed serious toxicity within days of being prescribed a combination of triamterene (50 mg) and hydrochlorothiazide (25 mg) for mild symptomless hypertension. Reduced clearance of lithium has been reported to follow its concurrent administration with diuretics that deplete both sodium and potassium. A combination of triamterene with thiazide has not been shown previously to precipitate lithium toxicity.
Plasma bilirubin and serum free fatty acids after myocardial infarction
Authors: Cowan R E , Thompson R P H , Kaye J P , Hall R J C
Published: December 2008

Fasting concentrations of plasma bilirubin were measured in 34 patients on admission to hospital and daily for 7 days after uncomplicated myocardial infarction. Mean concentrations increased significantly to reach maximum levels on the second day after admission, and fell during the following 5 days to reach the admission level by the 7th day. Unconjugated bilirubin accounted for most of this rise. Serum concentrations of free fatty acids (FFA), measured simultaneously in 12 patients, were highest within 12 hr of the onset of symptoms, when their level was significantly higher than at any time after the first day. It is suggested that the transient hyperbilirubinaemia after uncomplicated myocardial infarction is frequent and may result from interference by FFA with bilirubin metabolism.
Studies on apparent free cortisol and testosterone in plasma from patients with breast tumours
Authors: Jones M K , Dyer G I , Ramsay I D , Collins W P
Published: December 2008

The concentrations of cortisol and testosterone (total and apparent free) in peripheral venous plasma were measured in 147 women. The results showed that there were no significant differences in concentrations between women with normal breasts, those with histologically confirmed benign or malignant breast tumours and those with cancer at other sites. There was, however, a significant increase with age in the concentrations of total (P less than 0.005) and apparent free (P less than 0.02) cortisol.
Malakoplakia of the gastrointestinal tract
Authors: McClure John
Published: December 2008

The clinical and pathological features of 3 cases of colonic malakoplakia are documented thereby bringing to 34 the total of recorded cases of malakoplakia involving the gastrointestinal tract. This is therefore the most common site of involvement outside the urogenital tract. A comprehensive review of the world literature on gastrointestinal malakoplakia has been made and the characteristic features of the condition have been delineated. There was a bimodal age incidence with a small cluster of cases occurring in childhood and associated with significant additional systemic disease. In the adult cases the average age was 57 years with a slight excess of males. The most commonly involved part of the gastrointestinal tract was the colon and colonic carcinoma was the most common associated disease.
The changing pattern of toxicity of digoxin
Authors: Henry D A , Lowe J M , Lawson D H , Whiting B
Published: December 2008

Toxicity to digoxin was monitored in 437 consecutive recipients in a comprehensive drug surveillance programme, Adverse reactions developed in 19.5% and, in contrast to previous reports, were generally of a relatively benign nature. There were no drug-related deaths, but patients with adverse reactions spent longer in hospital. Low body weight, impaired renal function, old age and concurrent use of diuretics individually did not increase the risk of toxicity. This was attributed to improvements in the prescribing of digoxin. There was a highly significant excess of gastrointestinal reactions in women, which tended to occur early in the course of therapy. This susceptibility is not widely recognized. The use of loading doses may have caused many early reactions and it is suggested that this practice cold be abandoned in all but the most urgent cases.
Tuberculosis in maintenance haemodialysis patients. Study from an endemic area
Authors: Malhotra K K , Parashar M K , Sharma R K , Bhuyan U N , Dash S C , Kumar R , Rana D S
Published: December 2008

One hundred and fifty patients requiring maintenance haemodialysis were investigated to determine the incidence and pattern of tuberculosis. Twenty patients were found to have tuberculosis, giving an incidence of 13.3 times that of the general population. The most frequent clinical presentations of tuberculosis in these patients were pyrexia, pleural effusion and lymphadenopathy. Diagnostic difficulties were encountered in 7 patients in whom therapeutic trial with anti-tubercular drugs had to be undertaken. Two patients died from tuberculosis. Five patients received renal transplants after initial treatment of tuberculosis.
Failure to thrive associated with the Imerslund-Grasbeck syndrome
Authors: Campbell A N , Inglis J , Paynter A S
Published: December 2008

Two siblings are described who presented with failure to thrive and in whom a diagnosis of Imerslund-Grasbeck syndrome was made. Following treatment with i.m. hydroxocobalamin there was a good and rapid increase in weight and their haematology returned to normal.