bluuebunny/crossref_metadata_2025 huggingface dataset:
‘Tru-Cut’ needle biopsy of the liver: importance of the correct technique
Authors: Maharaj B , Pillay S
Published: December 2008

In order to determine which technique would provide adequate tissue for histological examination when the ‘Tru-Cut’ needle is used for liver biopsy, the livers of cadavers were biopsied by a single operator, under direct vision, using a ‘Tru-Cut’ needle. The modified breast biopsy technique either preceded or followed one of two alternative methods, one of which was recommended by the manufacturer, in a random manner. Thereafter, the biopsies were repeated using the alternative sequence.

The mean length of the liver biopsy specimens that were obtained using the modified breast biopsy technique was 16.3 mm (range: 8–20 mm). The corresponding figures for the manufacturerer's method were 7.7 mm (range: 2–14 mm) and for the third technique were 2.7 mm (range: 0.5–8 mm). Three of the 40 specimens (7.5%) obtained using the latter technique fragmented when placed in formalin; this did not occur in any of the 40 specimens taken using the modified breast biopsy technique.

This investigation indicates that the modified breast biopsy technique should be used when ‘Tru-Cut’ needle biopsy of the liver is performed. This provides specimens which are adequate for histological diagnosis. In addition, the safety of liver biopsy, which is compromised by poor technique, is improved. The alternative methods, including that recommended by the manufacturer, must be avoided.
RelapsingSalmonella enteritidisinfection in a young adult male with chronic granulomatous disease
Authors: Safe A F , Maxwell R T , Howard A J , Garcia R C
Published: December 2008

A case of chronic Salmonella enteritidis infection in a young adult patient is reported. Following an initial enteritis with bacteraemia, the illness lasted for a 7-year period and was characterized by recurrent pyrexia, anaemia, weight loss and marked hepatosplenomegaly.

Investigations revealed that the patient suffers from a mild form of chronic granulomatous disease presenting in adolescence.
Poor uptake of hepatitis B immunization amongst hospital-based health care staff
Authors: Burden A D , Whorwell P J
Published: December 2008

The uptake of hepatitis B vaccine was assessed amongst 100 medical and 100 nursing staff in a teaching hospital with a policy of recommending to those at risk that they should seek immunization from their general practitioners.

Sixteen per cent of nurses and 31% of doctors had completed a course of immunization with confirmation of seroconversion. An additional 9% and 18% respectively had been immunized without post-immunization serology. Ninety three per cent of nurses and 61% of doctors who had not been immunized would like to receive the vaccine. The commonest reasons for non-immunization amongst nurses were fear of vaccine and lack of advice, and amongst doctors, apathy and difficulty in obtaining the vaccine. Eighty seven per cent of medical staff and 57% of nurses had a history of needle stick injury.

The low rates of vaccine uptake in this study combined with the high incidence of needle stick injury calls for a reappraisal of present hepatitis B vaccination programmes in hospitals. In particular the abrogation of responsibility for immunization to general practitioners is probably a major disincentive to potential vaccines.
Guillain-Barré syndrome mistaken for brain stem death
Authors: Hassan T , Mumford C
Published: December 2008

A case of acute severe polyneuropathy in a previously healthy 45 year old male is presented. At the height of his illness the clinical picture was mistakenly interpreted as brain death. Spontaneous recovery occurred.
Recurrent bacterial meningitis occurring five years after closed head injury and caused by an intranasal post-traumatic meningo-encephalocele
Authors: Giunta G , Piazza I
Published: December 2008

A case of atypical presentation of a post-traumatic intranasal meningo-encephalocele is described in a patient with a history of recurrent bacterial meningitis occurring 5 years after closed head injury. The usefulness of the CT and MRI findings in diagnostic evaluation of this lesion is emphasized.
Anterior uveitis associated withMycoplasma pneumoniaepneumonia
Authors: Dawidek G M B
Published: December 2008

A case of Mycoplasma pneumoniae pneumonia complicated by anterior uveitis is described. Anterior uveitis as a complication has not been reported before. Its possible mechanism is discussed.
Congenital central alveolar hypoventilation syndrome (Ondine's Curse): effectiveness of early home ventilation for normal development
Authors: Chang Y L , Meerstadt P W D
Published: December 2008

An 8 month old Caucasian girl, with congenital central alveolar hypoventilation syndrome (Ondine's Curse), was discharged with her home ventilation managed by her parents. Her subsequent neurophysical development assessed at 22 months of age was satisfactory.
Vogt-Koyanagi-Harada syndrome, a rare association of Hodgkin's disease
Authors: Chuah S Y , Lyne A J , Dronfield M W
Published: December 2008

Vogt-Koyanagi-Harada syndrome (VKHS) is a well-documented clinical entity. We report the case of a 24 year old man who, within 5 months of the diagnosis of VKHS, developed Hodgkin's disease. Like VKHS, the aetiology of Hodgkin's disease is unknown. A viral factor has been suspected in the pathogenesis of both conditions. Similar immunological abnormalities have been described in both, and may be important predisposing factors.
The effect of caffeine on postprandial blood pressure in the frail elderly
Authors: Heseltine D , El-Jabri M , Ahmed F , Knox J
Published: December 2008

In a double-blind, random-order, cross-over study the effects of placebo and 100 mg of caffeine on postprandial sitting and erect blood pressure and heart rate were studied in 20 frail elderly subjects (mean age 84, range 75–93 years) after a standardized 400 K-calorie glucose drink. Maximal postprandial reduction in sitting systolic blood pressure occurred, at 60 minutes post-placebo, of − 11 mmHg (95% confidence interval −5 to −17 mmHg, P<0.01), and was attenuated by caffeine (P<0.05) with changes in systolic blood pressure, at 60 minutes post-drink, of 1 mmHg (95% CI −6 to 7 mmHg, not significant). Four subjects developed symptomatic postprandial hypotension after placebo which was prevented by caffeine. There were no significant changes in erect systolic blood pressure, postural systolic blood pressure change, sitting and erect, diastolic blood pressure and heart rate between treatment phases.

Caffeine attenuates the postprandial fall in sitting blood pressure in frail elderly subjects and in particular prevented symptomatic blood pressure reductions in subjects with postprandial hypotension.
Safety and efficacy of fluconazole treatment for Candida oesophagitis in AIDS
Authors: Gil A , Lavilla P , Valencia E , Pintado V , Dupla M L , Khamashta M A , García-Puig J , Ortiz-Vázquez J
Published: December 2008

The efficacy and safety of fluconazole in the treatment of oesophageal candidiasis in patients with the acquired immunodeficiency syndrome (AIDS) was assessed in 36 patients. Fluconazole, 200 mg orally, was given on the first day, followed by 100 mg daily for 4 weeks. Clinical and mycological evaluation was performed in 31 patients at the end of treatment and 24 were also assessed after 8 weeks of starting treatment. In 1 patient fluconazole was discontinued, 5 patients were lost to follow-up and 6 patients died during the study.

Clinical and mycological cure was achieved in all patients; in 31 of 36 patients the clinical picture resolved within a week. The cure was confirmed in 27 patients by oesophagoscopy. Two patients relapsed 1 month after stopping fluconazole but the reinstitution of therapy achieved cure. Asymptomatic fungal oropharynx colonization was evident in about 40% of patients during treatment and follow-up period. Fluconazole was well tolerated by all patients but mild to moderate increase of liver enzymes values occurred in 16. Treatment had to be discontinued in 1 patient with hepatic tuberculosis because of severe liver function abnormalities, but their relation with the drug was uncertain.

Fluconazole is an effective and safe treatment of oesophageal candidiasis in AIDS patients.
Congenital hypothyroidism—correlation between radiographic appearances of the knee epiphyses and biochemical data
Authors: Newland C J , Swift P G F , Lamont A C
Published: December 2008

Plain knee radiographs of 20 neonates with congenital hypothyroidism, were reviewed. The size and appearances of the epiphyses were compared with the biochemical data at the time of referral.

Fifteen infants had unequivocal evidence of delayed bone maturation based on absence of the distal femoral epiphysis or small epiphyseal size. Seven cases had fragmentation of at least one epiphysis.

A positive correlation was found, at diagnosis, between the thyroxine and triiodothyronine levels and the size of the knee epiphyses. All 14 infants with thyroxine levels of less than 70 nmol/l had small epiphyses with a combined mean diameter of the proximal tibial plus distal femoral epiphyses of 7 mm or less. Conversely, of the 6 infants with thyroxine levels of 70 nmol/l or above, 5 had combined epiphyseal diameters of greater than 10 mm.

We suggest that in infants with no clinical symptoms and only moderately raised raised screening thyroid stimulating hormone, a knee radiograph showing the described radiological changes should prompt institution of thyroxine treatment before awaiting biochemical confirmation of the diagnosis.
Arthritic presentation of childhood leukaemia
Authors: Bradlow A , Barton C
Published: December 2008

Three cases of childhood acute lymphatic leukaemia masquerading as juvenile chronic arthritis are presented. All had symptoms and signs for at least 4 months before leukaemia was diagnosed and in two the full blood count was normal at presentation. The importance of a high index of suspicion is emphasized, particularly if the white cell count is low.
The Dieulafoy gastric malformation: an under-recognized cause of massive upper gastrointestinal haemorrhage
Authors: Welch M , Hoare E M
Published: December 2008

The Dieulafoy gastric malformation is a rare cause of upper gastrointestinal haemorrhage. When no obvious bleeding lesion is seen at laparotomy this diagnosis ought to be considered. Three such cases were identified and treated with simple underrunning of the lesion with no mortality and minimal morbidity. Follow-up endoscopy in each patient showed complete healing of the lesion.
Histiocytosis X involving the thyroid and hypothalamus
Authors: Gaines P , Chan J C N , Cockram C S
Published: December 2008

A case of histiocytosis X involving the thyroid and hypothalamus is reported. A 16 year old female presented with amenorrhoea and diabetes insipidus. She subsequently developed a painful goitre with biochemical hypothyroidism, and stridor. The stridor and goitre responded to cyclophosphamide. Previous publications on the use of cytotoxics in histiocytosis X involving the thyroid are reviewed. We describe for the first time both the ultrasound appearances of the thyroid in this condition and the use of serial volumetric measurements to monitor therapy.
Medical disorders in Alzheimer's disease and vascular dementia
Authors: Förstl H , Cairns N , Burns A , Luthert P
Published: December 2008

The clinical and postmortem findings of 29 patients with Alzheimer's disease were evaluated and compared to the findings of 19 patients with vascular dementia. The patients with Alzheimer's disease had received treatment for an average of 2.0 internal medical disorders, the patients with vascular dementia for 2.1 disorders. The average number of medical diseases found at postmortem was 3.7 in the group with Alzheimer's dementia and 4.1 in vascular dementia. Apart from a marginally increased rate of peripheral occlusive artery disease in vascular dementia, the proportions of the most common disorders of the cardiovascular, genitourinary, gastrointestinal and endocrinological disorders and the most common causes of death did not differ significantly between these groups. Therefore patients with Alzheimer's disease should receive the same internal medical attention as patients with vascular dementia.
Delayed recovery of renal function in patients with acute renal failure due to accelerated hypertension
Authors: Yaqoob M , McClelland P , Ahmad R
Published: December 2008

Five patients with acute renal failure due to accelerated hypertension required regular dialysis treatment for 2–12 months (mean 8.8), before recovering sufficient renal function for dialysis to be withdrawn. Two patients who had prior evidence of chronic renal impairment remained off dialysis for 20 and 27 months before decompensating again to require regular dialysis treatment. Two patients with no prior history of renal disease have remained independent of dialysis for 32 and 48 months. The fifth patient was lost to follow-up after a 7 month dialysis-free period.

Delayed recovery of renal function following accelerated hypertension is a distinct possibility and should be considered in such patients before contemplating long term strategies such as renal transplantation.
Pulmonary fibrosis associated with nabumetone
Authors: Morice A , Atherton A , Gleeson F , Stewart S
Published: December 2008

A patient is described who developed a rapid onset of pulmonary fibrosis following treatment with a new non-steroidal anti-inflammatory drug, nabumetone. Resolution of symptoms, physical signs and radiographic changes followed drug withdrawal and steroid therapy.
Association of Addison's disease with autoimmune disorders—a long-term observation of 180 patients
Authors: Kasperlik-Zaluska A A , Migdalska B , Czarnocka B , Drac-Kaniewska J , Niegowska E , Czech W
Published: December 2008

This study aimed at evaluating the frequency of autoimmune disorders in Addison's disease. We have observed 180 patients (113 females, 67 males, aged 9–74 years) for 1 to 26 years. Tuberculosis was noted in 54 patients. Autoimmune disorders were found in 80 patients (44%); however, 125 (69%) patients were believed to have an autoimmune origin of adrenocortical insufficiency. In 20 patients two or more autoimmune disorders were found to coexist with Addison's disease.
Functional bowel symptoms in diabetes—the role of autonomic neuropathy
Authors: Maxton D G , Whorwell P J
Published: December 2008

The autonomic nervous system may have a role in the pathogenesis of irritable bowel syndrome. If so, the occurrence of irritable bowel symptomatology in patients with autonomic neuropathy might indicate which, if any, of these symptoms are dependent on autonomic innervation. The prevalence of abdominal pain, abdominal distension and an abnormal bowel habit was recorded in 200 patients with diabetes, screened for autonomic neuropathy, and 200 matched controls. Constipation was significantly more common in patients with autonomic neuropathy than in those without, or controls (22.0% vs 9.2% vs 6.8%). The prevalence of abdominal pain and abdominal distension was no different in patients with and without autonomic neuropathy and their respective controls. The results of this study suggest that control of bowel habit is more dependent on the total integrity of the autonomic nervous system than the perception of pain or the production of distension.
Partial splenectomy for massive splenomegaly secondary to Gaucher's disease
Authors: Thomas W E G , Winfield D A
Published: December 2008

A 16 year old girl with Type 1 Gaucher's disease presented with massive splenomegaly, hypersplenism and abdominal discomfort. Traditionally hypersplenism has been treated with splenectomy, but this results in a high incidence of overwhelming sepsis and accelerated sphingolipid deposition in both liver and bone. A 90% partial splenectomy was therefore performed leaving a fully vascularized inferior segment of the spleen and resecting 5.8 kg of splenic tissue. The patient made an uneventful recovery with a marked improvement in her haematological parameters and general condition.
Intestinal pseudo-obstruction due to amyloidosis of the colon in association with an intestinal plasmacytoma
Authors: Nicholl D , Jones T
Published: December 2008

A case of large bowel pseudo-obstruction due to colonic amyloidosis associated with an intestinal plasmacytoma is described. The association of an intestinal plasmacytoma with massive local amyloid deposition has not to our knowledge been previously reported.
Changing patterns of malaria in south-east Scotland: implications for practitioner awareness and prophylactic advice
Authors: Willocks Lorna , Jones Michael , Brettle Ray , Welsby Philip , Gray James
Published: December 2008

The medical records of all 229 patients with malaria admitted to the Edinburgh City Hospital between 1969 and 1988 were studied retrospectively. A total of 137 were from Africa, 44 from the Indian subcontinent, 19 from the Far East, 18 from New Guinea, 5 from the Middle East and 3 from South America. The number of yearly admissions rose markedly after 1983, mainly due to an increase in Plasmodium falciparum cases. Ninety-four cases (15 with severe parasitaemia) mainly from Kenya and Nigeria were due to P. falciparum infection and 99 to P. vivax. There were no deaths. A seasonal distribution of onset of fever in patients with P. vivax infections originating from the Indian subcontinent showed that most patients presented during the summer.

Prophylaxis had generally been irregular or non-existent but many compliant patients may have been receiving an inadequate dose of chloroquine on a mg/kg body weight basis. General practitioners are likely to see at least one case of malaria every 4 years. They are encouraged to seek advice from a specialist unit whenever necessary whether before or after their patient travels abroad. Travellers, in particular to Kenya and Nigeria, and Asian immigrants to the UK returning on holiday to their country of origin should be strongly advised to take regular prophylaxis including on return to the UK.
Erythromelalgia--the role of hypnotherapy
Authors: Chakravarty K , Pharoah P D P , Scott D G I , Barker S
Published: December 2008

Erythromelalgia is an unusual condition characterized by attacks of burning pain in the hands and feet with local congestion and increased skin temperature. We report a case of erythromelalgia, with transient hypertension and elevated urinary catecholamines successfully treated by hypnotherapy. Such an association has not to our knowledge been previously reported in English language publications.
Actinomycosis complicating chronic diverticulitis of the sigmoid colon: a missed association?
Authors: Samuel I , Dixon M F , Benson E A
Published: December 2008

The diagnosis and treatment of abdominal actinomycosis is difficult. We report a case of chronic diverticulitis of the sigmoid colon with stricture formation and obstruction, which was complicated by intramural actinomycosis. We suggest that diverticular strictures and actinomycosis may coexist more often than the literature suggests.
Malignant small cell tumour (Askin-Rosai) of the pericardium
Authors: Mohandas K M , Chinoy R F , Merchant N H , Lotliker R G , Desai P B
Published: December 2008

An Askin-Rosai tumour presenting as effusive constrictive pericarditis is reported. A 2-D echocardiogram was strongly suggestive of a primary pericardial tumour, and multiple pericardial and pleural aspiration failed to yield malignant cells. The final diagnosis was made at autopsy. Primary pericardial Askin-Rosai tumour has not to our knowledge been previously reported.
Extrapulmonary small cell carcinoma of bone
Authors: Raina Vinod , Milroy Robert , Al-Dawoud Abdul , Dunlop David , Soukop Michael
Published: December 2008

Small cell carcinoma has been reported to arise in many extrathoracic sites. However, such tumours arising from bone have not been previously described. We report what we believe is the first reported case of extrapulmonary small cell carcinoma of bone. The tumour arose from the fifth dorsal vertebra in a 60 year old woman. The patient was treated with local radiotherapy and combination chemotherapy and remains in remission, 18 months after diagnosis. As such extrathoracic small cell tumours are rare, there seem to be no clear-cut guidelines for treating them, but combination chemotherapy is recommended.
Raised blood urea in the elderly: a clinical and pathological study
Authors: Bowker Lesley K , Briggs R S J , Gallagher P J , Robertson Dorothy R C
Published: December 2008

We have attempted to define a normal range for blood urea and creatinine for elderly inpatients and to determine the relative importance of pre-renal, renal and post-renal pathology in those with renal impairment. A total of 118 admissions to an acute geriatric unit and 67 separate post mortems in patients over 67 years of age were studied prospectively. Up to 123 items of data were coded and analysed including blood urea and creatinine, clinical or pathological changes associated with renal disease, clinical outcome and post mortem findings. We determined our own 'normal' hospital ranges for urea (1.4-13.2 mmol/l) and creatinine (48-141 mumol/l) from plasma values in 76 patients with no evidence of renal impairment, either on admission or in the past. Using these values 41% of post mortem cases and 25% of clinical admissions had a raised blood urea. Pre-renal conditions such as cardiac failure, dehydration and gastrointestinal haemorrhage, either alone or in combination, were present in 56% of these patients. Urea and creatinine values were substantially higher in patients who died in hospital as opposed to those who were discharged or transferred. Creatinine values were greater in those with intrinsic renal disease or post-renal obstruction as compared to patients with pre-renal causes of renal impairment. Patients with histological evidence of extensive glomerulosclerosis or nephrosclerosis had higher urea and creatinine levels than those with only minor ageing changes.
Hypertension in aortic valve disease and its response to valve replacement
Authors: Zezulka Alexander , Mackinnon John , Beevers D G
Published: December 2008

We have investigated the prevalence of hypertension and the response of blood pressure to operation in 87 patients with lone aortic valve disease who underwent aortic valve replacement.

In patients with aortic stenosis alone 26% were hypertensive pre-operatively (age and sex adjusted blood pressure greater than 160 systolic and or greater than 95 mmHg diastolic) and 24% were hypertensive post-operatively. In those with aortic regurgitation alone, hypertension was present in 65% before and 57% after valve replacement using the same criterion. For combined stenosis and regurgitation, the prevalence was 54% and 62%, respectively.

The post-operative increase in systolic pressure in patients with aortic stenosis occurred mainly in those with a history of left ventricular failure. In those with aortic regurgitation or combined stenosis with regurgitation, diastolic pressure rose after valve replacement resulting in a prevalence of diastolic hypertension of 44% and 35%, respectively. Blood pressure changes were not predicted by the type of valve inserted nor its size.

Our data show that despite severe symptomatic aortic valve disease, systolic hypertension was common in aortic stenosis and diastolic hypertension was found in aortic regurgitation. This underlines the importance of blood pressure monitoring in patients following aortic valve replacement.
Glomerulonephritis associated with antibodies to neutrophil cytoplasm and glomerular basement membrane
Authors: McCance D R , Maxwell A P , Hill Claire M , Doherty C C
Published: December 2008

The prognosis for recovery of renal function of oligoanuric patients with anti-glomerular basement membrane disease is generally regarded as poor. Five patients are reported with dialysis-dependent renal failure in whom antibodies were present simultaneously both to neutrophil cytoplasm and glomerular basement membrane all of whom responded, at least initially, to immunosuppressive therapy and plasma exchange. Two of the 5 remain in clinical and immunological remission at 25 and 51 months of follow-up. We suggest that reversal of dialysis-dependent renal failure may be possible in some patients who display this dual antibody positivity.
Androgen-producing bilateral large cortical adrenal adenomas associated with polycystic ovaries in a young female
Authors: Micić D , Zorić S , Popović V , Janković R , Jancić M , Han R , Manojlović D , Mićić J
Published: December 2008

An association of bilateral large adrenocortical androgen-producing adenomas with polycystic ovaries in a young female is presented. She developed mild hirsutism and secondary amenorrhoea at the age of 17, and was treated for 3 years with an anti-androgen (cyproterone acetate) and ethinyloestradiol. Routine follow-up at the age of 21 showed bilateral large adrenal tumours and polycystic ovaries, together with high serum testosterone and dehydroepiandrosterone sulphate values. Bilateral adrenalectomy was performed, which resulted in lowering of the elevated androgens, and large bilateral adrenocortical adenomas were confirmed histologically. Contrary to expectations, the polycystic appearance of the ovaries persisted after adrenalectomy.

This case supports the possible role of adrenal androgens in the pathogenesis of polycystic ovaries as well as the possibility of the persistence of polycystic ovaries without adrenal androgens once they have developed.
Vocal cord paralysis and oesophago-broncho-aortic fistula complicating foreign body-induced oesophageal perforation
Authors: Taha A S , Nakshabendi I , Russell R I
Published: December 2008

A 61 year old man died after presenting with a 24 h history of haematemesis and haemoptysis, and one year history of hoarseness of voice. Post-mortem examination showed a dental plate eroding through the mid-oesophagus into a bronchus and into the descending arch of the aorta, with scarring suggestive of old perforation. An organized haematoma also involved the left recurrent laryngeal nerve. Vocal cord paralysis may be a manifestation of foreign body-induced oesophageal perforation, which can lead to death from an oesophago-broncho-aortic fistula. Both complications of oesophageal perforation from a foreign body have not to our knowledge been previously reported.
Horner's syndrome in severe tetanus
Authors: Syam B , Owens D
Published: December 2008

A 66 year old man was admitted with a left Horner's syndrome, and trismus due to tetanus. Three days later he had respiratory arrests, classical tetanic spasms and was ventilated. He had associated severe autonomic dysfunction, tachyarrhythmias, hypotension, sweating and constipation. There was complete resolution of the left Horner's syndrome with recovery from tetanus.
Metastatic cervical lymph nodes: general practitioner referral patterns
Authors: McRae Duncan , Buchanan George , Kenyon G S
Published: December 2008

Premature excision biopsy of a cervical lymph node infiltrated by metastatic carcinoma may compromise patient survival since it is associated with an increased incidence of local wound recurrence and distant metastases. Seventy per cent of such patients have an identifiable head and neck primary, obviating the need for an excision biopsy. It is important therefore that they are examined by surgeons who are experienced in inspecting the upper aerodigestive tract and who are competent in performing definitive head and neck surgery. A questionnaire sent to all general practitioners of an Inner London and a District Health Authority revealed that only 18% and 33% respectively referred patients who they suspected of having a metastatic neck node to a department with an experienced head and neck surgeon. We conclude that greater emphasis on the correct management of these patients at both an undergraduate and postgraduate level may encourage subsequent generations of general practitioners to review their referral patterns.
'The Health of the Nation': the impact of personality disorder on 'key areas'
Authors: Norton K R W
Published: December 2008

The purpose of this response paper is to document a form of mental illness, namely, personality disorder: (1) whose impact is far-reaching, impinging on different 'key areas' identified in 'The Health of the Nation' (The Health of the Nation: A Consultative Document. HMSO, London, 1991), including: eating and drinking habits, smoking, prevention of accidents, human immunodeficiency (HIV)/acquired immunodeficiency syndrome (AIDS), and other mental illness itself; (2) which tends to be underdiagnosed by health-care professionals in spite of its aetiological relationship to other 'key areas' (as above); (3) which tends to be associated with negative therapeutic attitude in spite of well-documented, albeit specialist, treatment expertise; (4) which, importantly, transmits psychopathology from one generation to the next and hence has a pivotal role to play in prevention; and (5) which, for the reasons enumerated above, could form a 'target' for various, measurable, interventions.
Guillain-Barré syndrome in Plasmodium falciparum malaria
Authors: Wijesundere Anula
Published: December 2008

A patient with Plasmodium falciparum malaria developed peripheral neuropathy. Clinical, cerebro-spinal fluid examination and nerve conduction studies confirmed Guillain-Barré syndrome, not previously reported in P. falciparum malaria.
Congenital left ventricular diverticula: a rare cause of sudden cardiac death
Authors: Speechly-Dick M E , Oliver R M , Slapak G I
Published: December 2008

Congenital left ventricular diverticula are a rare cause of sudden cardiac death. We describe the first reported case of ventricular fibrillation in association with congenital diverticula of the heart. The diagnosis of left ventricular diverticula was made by cardiac catheterization and confirmed by magnetic resonance imaging. Treatment was initiated with anti-arrhythmic and anticoagulant drugs to prevent life-threatening arrhythmias and emboli.
Addisonian crisis presenting with a normal short tetracosactrin stimulation test
Authors: Butcher Graham P. , Zambon Maria , Moss Steven , Walters Julian R.F.
Published: December 2008

We report the case of a 70 year old man who presented with physical and biochemical features suggestive of Addison's disease, but had a normal short tetracosactrin (Synacthen) test. Six months later he re-presented with similar clinical features but with an abnormal response to tetracosactrin confirming the diagnosis of Addison's disease. We recommend that if adrenal insufficiency is strongly suggested further investigation should be performed to exclude this diagnosis.
Suprasellar ectopic pituitary adenoma presenting as cranial diabetes insipidus
Authors: Luk K. H. , Lam Karen S.L. , Kung Annie W.C. , Fung C. F. , Leung S. Y.
Published: December 2008

We describe the occurrence of a supracellar ectopic pituitary adenoma in a 34 year old woman who presented with cranial diabetes insipidus and subsequently developed galactorrhoea-amenorrhoea. The tumour was demonstrated by both contrast computed tomography scan and magnetic resonance imaging with gadolinium enhancement and was confirmed at operation. Histological examination showed that the suprasellar lesion consisted of a pituitary adenoma while the pituitary biopsy revealed an unrelated pituitary microadenoma embedded in normal pituitary tissues. A review is made of the reported cases of ectopic pituitary adenomas.
Sub-clinical systemic lupus erythematosus presenting with acute myocarditis
Authors: Sandrasegaran K. , Clarke C. W. F. , Nagendran V.
Published: December 2008

A 46 year old woman presented with fever and normochromic anaemia followed rapidly by severe myocardial failure, unresponsive to maximum inotropic support and broad spectrum antibiotics. There were no classical clinical stigmata of systemic lupus erythematosus (SLE) but a possible immunological cause was looked for, and on the basis of her immuno-serology a diagnosis of SLE-like disease was made. She responded rapidly to high dose steroids. The importance of considering the possibility of SLE or 'lupus overlap' in an acutely ill 'undiagnosed' patient is emphasized. The relevance of instigating appropriate immuno-serological tests in the course of such an illness is discussed.
The evaluation of dizziness in elderly patients
Authors: Ahmad N , Wilson J A , Barr-Hamilton R M , Kean D M , MacLennan W J
Published: December 2008

Twenty-one elderly patients with dizziness underwent a comprehensive medical and otoneurological evaluation. The majority had vertigo, limited mobility and restricted neck movements. Poor visual acuity, postural hypotension and presbyacusis were also frequent findings. Electronystagmography revealed positional nystagmus in 12, disordered smooth pursuit in 18, and abnormal caloric responses in nine. Magnetic resonance imaging showed ischaemic changes in six out of eight patients. Although dizziness in the elderly is clearly multifactorial, the suggested importance of vertebrobasilar ischaemia warrants further consideration as vertigo has been shown to be a risk factor for stroke.
Peptic oesophageal stricture: an age-related problem?
Authors: Gainsborough N , Powell-Jackson P
Published: December 2008

A one year retrospective study of 76 patients with peptic oesophageal stricture was performed. Analysis of results showed a significant age-related risk of developing peptic oesophageal stricture. Possible age-related risk factors are discussed. Pitfalls in diagnosis and management are highlighted and the role of H2 receptor antagonists, antacids and omeprazole are discussed.
Bilateral carpal tunnel syndrome associated with interleukin 2 therapy
Authors: Heys S D , Mills K L G , Eremin O
Published: December 2008

We report the development of synchronous bilateral carpal tunnel syndrome in a woman with metastatic colorectal cancer, undergoing treatment with recombinant interleukin 2. A carpal tunnel decompression was carried out on the hand which was more severely affected, with a gradual recovery in median nerve function. To the best of our knowledge, this is the first reported case of carpal tunnel syndrome in association with recombinant interleukin 2.
Suppurative thyroiditis with oesophageal carcinoma
Authors: Premawardhana L D K E , Vora J P , Scanlon M F
Published: December 2008

A 68 year old, previously well woman presented with dysphagia, weight loss and a neck swelling. Investigations revealed a right-sided thyroid abscess with fistulous connection to the upper of two oesophageal carcinomas, a previously unreported association. The resistance of the thyroid to infection and the mechanisms of thyroid abscess formation in this patient are discussed.
Concentrations of vitamins A, C and E in elderly patients with Parkinson's disease
Authors: King D , Playfer J R , Roberts N B
Published: December 2008

Concentrations of the naturally occurring antioxidant vitamins A, C and E were measured in 27 patients with Parkinson's disease and 16 age-matched control subjects, from a similarly disabled patient group. There was no significant difference in the serum concentrations of vitamins A and E in the two groups. Vitamin C was significantly higher (P < 0.05) in the Parkinson's disease group, however, the mean leucocyte vitamin C concentration in the control group was low (101 nmol/10(8) WBCS) compared to established data in healthy young individuals (119-301 nmol/10(8) WBCS). There was no correlation between the severity or duration of Parkinson's disease and concentrations of vitamins A, C and E. There is therefore no evidence from this study that a deficiency of these antioxidants contributes to the onset or progress of Parkinson's disease.
Microalbuminuria in non-insulin-dependent (type 2) Nigerian diabetics: relation to glycaemic control, blood pressure and retinopathy
Authors: Erasmus R T , Oyeyinka G , Arije A
Published: December 2008

Twenty-four hour urinary albumin concentrations were measured in 113 (mean age 51.1 years) non-insulin-dependent (NIDDM) Nigerian diabetics (50 males, 63 females). A high prevalence of microalbuminuria (> or = 30 mg/24 hour) was observed in male (54%) as well as female diabetics (59%). Microalbuminuria was also observed in a high proportion of diabetics (52%) with a short duration (< 5 years) of disease. Elevated blood pressure and retinopathy were present in 41% and 16% of patients respectively. Among the 49 patients with normoalbuminuria (< 30 mg/24 hour), six (12%) had retinopathy compared with 12 (18%) in the microalbuminuria group. Diastolic blood pressure levels were significantly higher (P < 0.01) in male diabetics with retinopathy but this was not associated with higher albuminuria. Urinary albumin concentrations were not influenced by elevated blood pressure. There were no significant differences in age, duration of diabetes, blood pressure or serum creatinine between diabetics with and without microalbuminuria. These results suggest that though there is a high prevalence of microalbuminuria amongst NIDDM Nigerian diabetics it may not predict retinopathy and occurs independently of either glycaemic control or elevated blood pressure levels.
Magnetic resonance imaging for the assessment of residual masses after treatment of non-Hodgkin's lymphomas
Authors: Montalbán Carlos , Rodríguez-García Jose Luis , Mazairas Luis , Ayala Inmaculada , Marcos-Robles Jose
Published: December 2008

Eight patients with non-Hodgkin's lymphoma who were in clinical remission but showed residual masses after therapy were examined with magnetic resonance imaging at 1.5 T at the end of therapy, with the sequences TR/TE:500/35,500/70,2000/35 and 2000/70. Residual masses were found in lymphoid areas (7), spleen (3) and kidney (1). In three patients, T2 showed high signal intensity. Disease progressed in the following 1-3 months and active lymphoma was histologically identified. In the other five patients, T2 showed a very low signal intensity. One of them had a distant relapse in lymphoid areas but the remaining four patients are asymptomatic after a mean follow-up time of 13 months, suggesting that the lymphoma is cured and the mass inactive.

We conclude that magnetic resonance imaging seems to distinguish active from non-active residual masses after treatment of non-Hodgkin's lymphoma patients otherwise in clinical remission.
In situ demonstration of Epstein-Barr virus in intravenous drug abusers with generalized lymphadenopathy
Authors: Mampaso F , Bellas C , Molina A , Quereda C , Bricio T , Buzon L
Published: December 2008

We have studied by the in situ hybridization method the presence of Epstein-Barr virus (EBV) DNA genome in lymph node tissues from 11 patients with persistent generalized lymphadenopathy. Using a biotinylated EBV DNA probe, we demonstrated EBV nucleic acid in scattered germinal centre cells in eight of the 11 cases. Our results suggest that EBV is not a determinant factor in the pathogenesis of this lymphadenopathy, but support its possible implication in B cell malignant transformation in cases of AIDS-associated lymphoma.
Acute myocardial infarction related to smoke inhalation and myocardial bridging
Authors: McCabe Michael J , Weston Clive F M , Fraser Alan G
Published: December 2008

A previously healthy 26 year old woman who was exposed to smoke during a house fire developed acute anterior myocardial infarction complicated by ventricular fibrillation. Subsequent left ventriculography confirmed anterior infarction, but coronary arteriography was normal apart from myocardial bridging over a segment of the left anterior descending artery. The development of acute myocardial infarction in this patient suggests that, in the presence of bridging, carbon monoxide inhalation may cause regional infarction.
Patient recovery following cholecystectomy through a 6 cm or 15 cm transverse subcostal incision: a prospective randomized clinical trial
Authors: O'Dwyer P J , McGregor J R , McDermott E W M , Murphy J J , O'Higgins N J
Published: December 2008

The effect of incision length on patient recovery following cholecystectomy has not been investigated previously. In this study, 30 patients with symptomatic gallstones were randomized to cholecystectomy through a 6 cm or 15 cm transverse subcostal incision. Postoperative hospital stay was significantly shorter in the 6 cm incision group (median 3 days vs 5 days; P = 0.0069 Mann-Whitney U-test). In the 6 cm group analgesic requirements were reduced (median 2.5 vs 4.5 intramuscular opiate injections per patient) and recovery of depressed postoperative pulmonary function (FVC and FEV1) was faster (3% difference between groups on day 1 and 7% on day 3), although these differences did not achieve statistical significance. These results suggest that the length of incision may influence patient recovery following elective cholecystectomy. This has important implications as surgery carried out through shorter and less traumatic incisions may offer a cost-effective alternative to laparoscopic cholecystectomy. Moreover, some surgeons may find mini-laparotomy cholecystectomy easier to adopt than laparoscopic techniques.
The effect of hemiplegia on blood pressure measurement in the elderly
Authors: Dewar R , Sykes D , Mulkerrin E , Nicklason F , Thomas D , Seymour R
Published: December 2008

The blood pressure in both arms of 103 unselected hemiplegic patients was measured using a random-zero sphygmomanometer. Although for the whole sample the mean blood pressure in the paretic and unaffected arm was similar, a significant difference was found when the patients were subdivided according to the tone of the arm. The blood pressure was higher in paretic arms of patients with a spastic stroke and lower in the affected arm if the tone was flaccid. No other characteristics were associated with significant blood pressure differences, so that the findings appear to be directly related to changes in muscle tone. After a stroke the blood pressure should always be measured in the unaffected arm because changes in tone make measurements unreliable.
The differing predictive values of oestrogen receptor assays for large breast cancers
Authors: Gaskell D J , Hawkins R A , Tesdale A L , Sangster K , Chetty U , Forrest A P M
Published: December 2008

Thirty elderly patients with T3 or T4 breast cancer underwent a wedge biopsy for radioligand-binding assay (RLA) of oestrogen receptor (ER) activity. A second, separate group of 21 elderly patients with T3 and T4 breast cancers underwent fine needle aspiration biopsy (FNA) for immunocytochemical assay of ER (ER-ICA). All the women received tamoxifen as primary treatment and response was assessed by UICC criteria. Tumour ER concentration by RLA was correlated with both response (Spearman's R = + 0.52) and time to progression (R = + 0.76). Nine patients with receptor-rich tumours (> 100 fmol/mg protein) failed to show a response. However, the percentage of cells staining for ER by ER-ICA assay was much more strongly related to the likelihood of response (R = + 0.89); no patient with < 20% cells staining responded. Wedge biopsy and the biochemical determination of ER activity is of limited value in predicting the likely response to tamoxifen; ER-ICA assays on such tumours may be more informative.
Crohn's disease in Bangladeshis and Europeans in Britain: an epidemiological comparison in Tower Hamlets
Authors: Probert C S J , Jayanthi V , Pollock D J , Baithun S I , Mayberry J F , Rampton D S
Published: December 2008

The incidence of Crohn's disease in a defined Bangladeshi community was assessed in a retrospective, epidemiological study in the London Borough of Tower Hamlets from 1972 to 1989. The borough population of 164,000 includes over 28,000 Bangladeshis. Potential cases were identified from hospital pathology and medical records. There were 99 cases of Crohn's disease during the study period, of which five were Bangladeshi. The mean standardized incidence in Bangladeshis was 1.2/10(5)/year in the 1970s and 2.3/10(5)/year in the 1980s compared with 3.8/10(5)/year and 4.1/10(5)/year in Europeans, and 4.6/10(5)/year and 5.4/10(5)/year in West Indians, respectively. None of the changes with time was statistically significant. There were no cases amongst Hindus. The relative risk to Europeans, compared to Bangladeshis, was 2.5 during the 1970s and 2.0 in the 1980s. The difference between European incidence and that of other ethnic groups was not statistically significant; however, the number of Bangladeshi cases was small (five), and diminishes the power of the study. The apparent similarity of the incidences of Crohn's disease in Bangladeshis and Europeans contrasts with findings in other South Asians. Further investigations of the differences in incidence of Crohn's disease in South Asians is needed.
Carnitine deficiency associated with long-term pivampicillin treatment: the effect of a replacement therapy regime
Authors: Rose S J , Stokes T C , Patel S , Cooper M B , Betteridge D J , Payne J E
Published: December 2008

A 51 year old female developed a skeletal muscle myopathy after 3 months of pivampicillin therapy. Pivampicillin can cause carnitine deficiency due to the pivalic acid side group. Plasma carnitine content and the patients symptoms failed to improve significantly on discontinuing the drug. Oral carnitine replacement therapy was administered for 6 weeks but the patient's plasma carnitine levels responded only slowly to this treatment. It is suggested that pivampicillin inhibits uptake of carnitine from the gut and may either directly or indirectly depress endogenous carnitine synthesis. In such cases a more aggressive carnitine replacement regime is indicated and pivampicillin should be avoided in patients requiring long-term antibiotic administration.
Amoebic psoas and liver abscesses
Authors: O'Leary Colin , Finch Roger
Published: December 2008

A 28 year old woman with a history of a dysenteric illness and documented Campylobacter infection presented with amoebic psoas and liver abscesses. A review of the literature of the last 20 years did not yield any reports of an amoebic psoas abscess.
Strongyloides stercoralis hyperinfection in a patient with angioimmunoblastic lymphadenopathy
Authors: Uwaydah Ahmad K , Al Qadah Farouq
Published: December 2008

A 29 year old Bengali male patient on chemotherapy for angioimmunoblastic lymphadenopathy developed Strongyloides hyperinfection syndrome 3 months after being treated with a single 3 day course of thiabendazole. His complicated hospitalization and successful management are described. Prevention of this potentially fatal disease in immunocompromised patients by early diagnosis and proper management of intestinal strongyloidiasis is emphasized.
Familial Conn's syndrome
Authors: London Nicholas , Swales John , Hollinrake Ken , Bell Peter , Heagerty Anthony
Published: December 2008

We describe the occurrence of primary hyperaldosteronism in two sisters. Although this is only the second published report of familial Conn's syndrome, it does have implications for the relatives of patients with Conn's syndrome and these are discussed.
The anti-inflammatory and analgesic action of transdermal glyceryltrinitrate in the treatment of infusion-related thrombophlebitis
Authors: Berrazueta J R , Poveda J J , Ochoteco J , Amado J A , Puebla F , Salas E , Sarabia M
Published: December 2008

We have carried out a prospective double-blind randomized study in 40 patients with infusion-related thrombophlebitis. Twenty-two patients were included in the glyceryltrinitrate (GTN) ointment group and 18 patients in the control heparinoid group. Pain was assessed by an analogue scale. At 48 hours the analgesic index was 84.6 +/- 18 units with GTN and 49 +/- 45 units with heparinoid ointment (P < 0.01). Faster relief of oedema was also observed in the GTN-treated group. All signs of thrombophlebitis were relieved in less than 4 days in the GTN group compared with 9 days in the controls (P < 0.005). We conclude that transdermal GTN is useful therapy for infusion-related thrombophlebitis showing evidence of anti-inflammatory and analgesic effect.