bluuebunny/crossref_metadata_2025 huggingface dataset:
Fulminant hepatic failure in non-Hodgkin’s lymphoma
Authors: Braude S , Portmann B , Gimson A E S , Williams Roger
Published: December 2008

Two patients with fulminant hepatic failure presenting during the course of non-Hodgkin’s lymphoma are described. One patient had no previous history of lymphoma whereas in the other a small bowel lymphoma had recently been diagnosed. Both patients had histological evidence of lymphomatous infiltrate in the liver and no other cause for the fulminant hepatic failure could be found. Neither patient responded to treatment with corticosteroids: the cautious use of combined chemotherapy may be justified.
Liver disease in brucellosis. A clinical and pathological study of 40 cases
Authors: Cervantes F , Carbonell J , Bruguera M , Force L , Webb S
Published: December 2008

Among 82 patients with brucellosis, physical and/or biochemical abnormalities suggesting liver disease were found in 40 cases. A soft and tender liver enlargement was present in 65% of them, and the spleen was palpable in 52%. The most frequent biochemical abnormalities were a slight increase of serum transaminases and alkaline phosphatase. Liver biopsy showed a non-specific reactive hepatitis in 90% of patients, and minimal changes in the remaining 10%. Non-caseating granulomas were present in 28 patients, always associated with reactive hepatitis. No differences were found when comparing clinical and biochemical features in patients with and without granulomas. However, statistically significant differences were obtained when the duration of the process was related to the type of alteration found in the liver biopsy; the finding of granulomas was practically constant when the duration of the disease before liver biopsy was under 100 days, but was infrequent after this time.
The role of race and environment in the development of hyperosmolar hyperglycaemic non-ketotic coma
Authors: Knight Graham , Leatherdale Brian A
Published: December 2008

In a retrospective study of patients presenting with hyperosmolar hyperglycaemic non-ketotic coma no evidence was obtained to suggest that the condition occurs more commonly in black patients. Suspicions that poor social background rather than race predisposes patients to the condition are borne out by the fact that 10 of the 13 patients were socially isolated.
Polymyositis presenting as sick sinus syndrome
Authors: Reid Peter G , Griffiths B E , McQueen I N F , Dalal J J
Published: December 2008

A 39-year-old woman presented with palpitations, presyncope and muscular weakness. Electrocardiographic monitoring and electrophysiological studies confirmed the tachycardia-bradycardia form of the sick sinus syndrome and subsequent investigations including an endomyocardial biopsy demonstrated polymyositis as the cause.
Early onset life-threatening myelosuppression after low dose of intravesical thiotepa
Authors: Agnelli Giancarlo , Gresele Paolo , de Cunto Maria , del Favero Albano
Published: December 2008

Intravesical instillation of thiotepa is a popular treatment for localized bladder carcinoma. The drug can enter the systemic circulation, and such absorption may be enhanced by extensive tumour infiltration or by a recent tumour resection. A case is reported of early onset life-threatening pancytopenia following an unusually low dose of the drug in a patient who had undergone a recent tumour resection.
Crohn’s disease of the colon with Takayasu’s arteritis
Authors: Lenhoff S J , Mee A S
Published: December 2008

A case of Crohn’s disease of the colon with Takayasu’s arteritis in a young woman is presented. A possible pathogenetic mechanism whereby circulating immune complexes associated with Takayasu’s arteritis could lead to a chronic colitis is proposed.
Does multiple injection sclerotherapy have a role in the long-term management of oesophageal varices?
Authors: Sinnett H D , Reynolds K W , Murray-Lyon I M , Johnson A G
Published: December 2008

Sixty-nine cirrhotic patients were treated by injection sclerotherapy for bleeding oesophageal varices, with an emergency hospital mortality, from all causes, of 29%. The treatment of 35 of these continued with elective, long-term injections alone: 9 have so far survived more than 3 years, the longest being 5 years 4 months. The risk factor for rebleeding per patient month was 0·03 and, with its minimal complications, long-term sclerotherapy can be recommended as an alternative to portasystemic shunts for all grades of liver disease.
Transplacental transfer of 25-hydroxy-cholecalciferol
Authors: Gupta M M , Kuppuswamy G , Subramanian A R
Published: December 2008

Plasma calcium, inorganic phosphorus, alkaline phosphatase, magnesium and 25-hydroxy-cholecalciferol (25-OH-D3) levels were determined on venous blood in 60 Indian mothers during labour. The same analyses were carried out on the cord blood and the infant’s venous blood 96 hr after birth. The mean values of plasma calcium, inorganic phosphorus and magnesium were significantly raised in the cord blood compared to those in the maternal blood (calcium and phosphorous P<0·001 and magnesium P<0·01). The mean plasma levels of 25-OH-D3 in the maternal and cord blood were 11·7 ng/ml and 9·6 ng/ml respectively, the cord blood level being about 81% of the maternal. There was a highly significant correlation between these concentrations (r=0·80, P<0·001). The plasma 25-OH-D3 was subnormal in 12 pregnant mothers at labour and 14 infants.

The study highlights the low vitamin D state of Indian pregnant mothers and their newborn infants. The plasma 25-hydroxy-cholecalciferol in pregnancy may reach subnormal levels which are often associated with clinical osteomalacia. This, in turn, adversely affects the vitamin D state of the infant.
Neurological and psychiatric side effects of cimetidine—report of 3 cases with review of the literature
Authors: Sonnenblick M , Rosin A J , Weissberg N
Published: December 2008

Neurological and psychiatric side effects of cimetidine are reviewed in 47 cases from the literature, and 3 further cases are described. Confusion, psychomotor restlessness, hallucinations and disorientation, stupor and coma were the main features; some had convulsions and a few exhibited focal neurological deficits or neuropathies. The signs appeared within 2 days in almost half of the patients, and remitted in most within 2-3 days. Predisposing factors, of which more than one may be present, are advanced age, hepatic or renal dysfunction, or severe underlying disease. The 3 cases described were all old, one had cirrhosis with bleeding oesophageal varices, and one had renal failure with nephrotic syndrome and amyloidosis.

In view of the increasingly wide use of cimetidine, conditions in which there is decreased metabolic breakdown, or excretion, or predisposition to increased brain levels should prompt careful follow-up, and possibly a lower dosage regimen, especially in elderly patients.
Wernicke’s encephalopathy following ‘hunger strike’
Authors: Pentland Brian , Mawdsley Clifford
Published: December 2008

A 41-year-old doctor who voluntarily starved himself and developed Wernicke’s encephalopathy after intravenus rehydration is described. The need to be aware of this complication of dextrose infusion in the undernourished non-alcoholic patient is emphasized.
Turner’s syndrome associated with bicuspid aortic stenosis and dissecting aortic aneurysm
Authors: Slater D N , Grundman M J , Mitchell L
Published: December 2008

A case of Turner’s syndrome is described associated with bicuspid aortic stenosis and fatal rupture of a thoracic dissecting aortic aneurysm. Histology of the aneurysm showed severe cystic medial necrosis. This association has not been previously described in the absence of coarctation.

In view of the possibility of surgical repair, dissecting aortic aneurysm should be considered in all patients with Turner’s syndrome presenting with chest pain, irrespective of the presence or absence of coarctation.
Pernicious anaemia in a young man presenting with dyspepsia
Authors: Semple C G , Williamson J M
Published: December 2008

An otherwise healthy 17-year-old male presented with a 6-month history of nausea and vomiting. He was shown to have Addisonian pernicious anaemia, the treatment of which resulted in resolution of his gastrointestinal symptoms.
Atropine and paralytic ileus
Authors: Beatson Neil
Published: December 2008

A patient who developed paralytic ileus while on atropine therapy is described, and this complication of atropine-like drugs is reviewed.
Recovery without sequelae from severe methanol intoxication
Authors: Martens J , Verberckmoes R , Westhovens R , Delooz H , Daenens P
Published: December 2008

A case of massive methanol poisoning is described. The peak serum methanol level of 287·5 mmol/litre (920 mg/dl) is by far the highest recorded level associated with complete recovery. This successful outcome can probably be attributed to early and prolonged haemodialysis.
Polyneuritis following BCG re-vaccination
Authors: Katznelson D , Gross S , Sack J
Published: December 2008

A 12-year-old healthy, tuberculin negative boy was re-vaccinated with BCG. Nine days later symmetrical polyneuritis developed in all extremities. The tuberculin test was now strongly positive. It is suggested that the polyneuritis was due to a hypersensitivity reaction resulting from the BCG re-vaccination.
Meningioma of the third ventricle
Authors: Rodrigues E A , Lawson A A H
Published: December 2008

A case of meningioma located in the posterior part of the third ventricle is presented. A review of the common presentations and current trends in management is included.
Neuropsychiatric manifestations of bromide ingestion
Authors: Battin David G J , Varkey T Antony
Published: December 2008

Two cases of bromide intoxication are reported. Although the serum bromide levels were not particularly high, they were related to typical neurological and psychiatric features of bromism. The authors wish to suggest that the rare syndrome of bromism be considered in the differential diagnosis of obscure or refractory neuro-psychiatric symptomatology.
The distal form of spinal muscular atrophy: an unusual case demonstrating the intermediate variety
Authors: Isenberg D A , Kahn Pauline A
Published: December 2008

A 14-year-old boy with a long history of distal muscle weakness affecting primarily and predominantly the upper limbs is described. There is a family history of pes cavus and congenital dislocation of the hip. Electromyography and histopathological studies of skeletal muscle showed conclusive evidence of a neurogenic muscular disorder, and excluded primary muscle disease. The muscle biopsy showed group atrophy. As many target fibres which are identical to structured cores were a prominent feature of the biopsy, central core disease was considered. However, it was concluded on clinical, neurophysiological and histological evidence that the patient was suffering from distal spinal muscular atrophy of an intermediate type designated by previous authors.

A review of the current concepts of distal muscle weakness is included.
Plasma infusions in thrombotic thrombocytopenic purpura complicating systemic lupus erythematosus—a successful outcome
Authors: Finkelstein R , Markel A , Carter A , Brook J G
Published: December 2008

A severe form of acute thrombotic thrombocytopenic purpura (TTP) developed in a patient with systemic lupus erythematosus (SLE). Infusions of large amounts of fresh frozen plasma (FFP) were added to steroid therapy and resulted in a rapid improvement and remission. Further episodes of thrombocytopenia and abdominal pains during a two-year follow-up were successfully treated with plasma alone and this indicates the important role of FFP infusions in the recovery of this patient.
Ulcerative colitis complicated by a leucoerythroblastic anaemia
Authors: Chesner I M , Gozzard D I
Published: December 2008

Two cases of biopsy-proven ulcerative colitis are described, and both developed a leucoerythroblastic anaemia during the course of the acute illness. Despite intensive investigation for the presence of bone marrow infiltration, no neoplasm was demonstrated. The leucoerythroblastic anaemia remitted in each case on medical treatment of the ulcerative colitis. The possible mechanisms underlying the development of reversible leucoerythroblastic anaemia are discussed.
Hepatitis B among Indochinese refugees in Great Britain
Authors: Chadwick R G , Hall A J , Davidson I , Bull F G , Wright R
Published: December 2008

Six hundred and thirty-two blood samples from 879 consecutive admissions to one resettlement camp for Indochinese refugees in Great Britain were screened for markers of hepatitis B (HB) virus infection. The overall prevalence of HB surface antigen (HBsAg) was 15%, being 16% in those aged 40 years or less, and falling to 8% in those older than 40 (P less than 0.05). No significant difference in prevalence was found between males and females. HBe antigen was detected in 56% of those with HBsAg and was demonstrable in 55-76% of those under 30 years of age. HBe antibody was found in 21% of HBsAg-positive refugees. In those under 40 years old, HB core (HBc) antibody was commoner in males (P less than 0.01). HBc antibody prevalence increased significantly with age in females (P less than 0.01) but not in males. There was no definite evidence that vertical transmission of hepatitis B was present in the group studied.
Aortic aneurysm in a patient with long-standing hypothyroidism
Authors: Savage C , Deanfield J E , Jung R T
Published: December 2008

Hypothyroidism over a lifetime is rare. Such a case is reported due to post-coupling dyshormonogenesis in a patient who had developed an aortic aneurysm. It is proposed that the aortic aneurysm could have arisen as a direct consequence of the hypothyroidism. Furthermore, Reilly bodies, which are deposits of mucopolysaccharide, were found in the peripheral blood leucocytes; these have never been previously described in hypothyroidism. It is suggested that they may reflect an underlying disturbance in mucopolysaccharide turnover which could have resulted in weakening of the aortic wall and aneurysmal formation.
Spontaneous carotid-cavernous fistula with ophthalmoplegia and facial palsy
Authors: Kapur Anil , Parikh N K , Shanghavi N G , Amin S K
Published: December 2008

A hypertensive patient presenting with facial palsy and ophthalmoplegia following a spontaneous carotid-cavernous fistula is presented. The mechanism of facial palsy in such cases is discussed.
Chlamydial infection as a possible aetiological factor in the Guillain-Barré syndrome
Authors: Grattan C E H , Berman P
Published: December 2008

Two cases of Guillain-Barré syndrome are reported with serological evidence of recent Chlamydia psittaci infection. It is suggested that the chlamydial infection may have precipitated the neurological syndrome.
Acute uric acid nephropathy: a complication of phencyclidine intoxication
Authors: Patel Raman
Published: December 2008

Although cases of myoglobinuric acute renal failure in phencyclidine abuse have been reported there are no previous reports of acute renal failure due to hyperuricaemia in this condition. Two cases of acute uric acid nephropathy associated with phencyclidine intoxication are described.
Hairy cell sarcoma
Authors: Waxman Jonathan H Y
Published: December 2008

The first case of a hairy cell sarcoma is presented. Subsequent to surgical resection and post-operative radiotherapy the patient has survived two years without systemic evidence of hairy cell leukaemia.
Acute pulmonary embolism following air travel
Authors: Ledermann J A , Keshavarzian Ali
Published: December 2008

Three cases of pulmonary embolism following long air flight are described. There was no previous history of venous disease. The symptoms were transient in one and severe in two. The occurrence of pulmonary embolism immediately after air travel is emphasized.
Intrarenal teratoma
Authors: Prasad S B
Published: December 2008

Intrarenal teratomas are extremely rare. A case of intrarenal teratoma in an adult is reported.
Terminal care: evaluation of effects on surviving family of care before and after bereavement
Authors: Cameron Jean , Parkes Colin Murray
Published: December 2008

To evaluate the effects on the family of a comprehensive programme of terminal cancer care, 20 close relatives of patients who had died in a Palliative Care Unit (PCU) were compared with a matched group of 20 relatives of patients who had died of cancer in other wards of the same teaching hospital.

Interviewed by telephone 1 year and 2 weeks after bereavement, relatives of PCU patients report significantly fewer psychological symptoms and less lasting grief and anger than relatives of patients who had died elsewhere.

Factors thought to have contributed to good outcomes were successful relief of pain, awareness by relatives of the coming death of the patient and support given to relatives after bereavement. Two case examples illustrate these findings.
Sutureless skin closure for pacemaker implantation: comparison with subcuticular suture
Authors: Pitcher D
Published: December 2008

In 51 patients undergoing pacemaker implantation a trial was carried out to compare the results of sutureless skin closure using a new product (Op-Site skin closures) with skin closure using a continuous subcuticular absorbable (Dexon) suture. Incisions closed with Op-Site skin closures healed as well as those closed with subcuticular suture but were associated with less frequent and less extensive erythema around the skin edges one week after the procedure. They were quicker, simpler and cheaper to apply than the suture material used in this study.
Pathological aspects of endomyocardial fibrosis
Authors: Olsen E G J
Published: December 2008

The studies leading up to the unitarian concept suggesting that endomyocardial fibrosis, described in the tropics, and Löffler’s endocarditis parietalis fibroplastica (Löffler’s endomyocardial disease), described in the temperate zone, belong to the same disease spectrum are detailed. Evidence that the eosinophil is involved in the pathogenesis of endomyocardial diseases, irrespective of the geographical origin, is presented. The findings of a similar abnormality in these cells obtained from patients in the tropical and temperate zones are briefly mentioned. In view of the evidence it is proposed that endomyocardial disease, associated with abnormal eosinophils, hitherto classified under the restrictive type of cardiomyopathy, be removed from this classification and reclassified under ‘specific heart muscle disease’.
Rheumatic symptoms in primary hyperparathyroidism
Authors: Helliwell M
Published: December 2008

In a retrospective survey of 34 patients with primary hyperparathyroidism (HPT), 18 (53%0 complained of musculo-skeletal symptoms during the 12 months before the diagnosis was made and 9 (26%) attended at some time for either a rheumatological or orthopaedic consultation. Myalgia was the most frequently reported symptom which occurred in 41% of patients. Arthralgia, mainly affecting the large joints was present in 11 (32%) patients, 2 of whom had an erosive synovitis mimicking rheumatoid arthritis. Radiological abnormalities were seen in 8 patients. Clinicians should be aware of the variety and frequency of musculo-skeletal symptoms associated with HPT and should consider including serum calcium measurements when investigating rheumatic complaints.
Unusual presentation of primary klebsiella meningitis: successful treatment with cefotaxime
Authors: Sandyk R , Brennan M J W
Published: December 2008

A man who presented with lumbar backache subsequently developed signs of meningitis. The causative organism was proved to be Klebsiella pneumoniae. Despite treatment with chloramphenicol and amikacin, the condition progressed until cefotaxime was added to the treatment regimen. The patient made a good recovery. This is the first report of the use of cefotaxime in klebsiella meningitis.
Nodal bradycardia induced by tocainide
Authors: Mandal S K , Datta S K
Published: December 2008

A case of tocainide-induced nodal bradycardia in standard recommended dose is reported. There was no recurrence when the drug was subsequently reintroduced in a reduced dosage. It is suggested that in the elderly, tocainide should be used in a lower dosage than normally recommended.
Vaginal bleeding due to leech
Authors: Prasad S B , Sinha M R
Published: December 2008

An unusual presentation of leech infestation leading to vaginal bleeding is reported.
Alpha 2HS-glycoprotein in the serum and urine of patients with renal diseases
Authors: Kishore B K , Gejyo F , Arakawa M
Published: December 2008

The concentration of alpha 2HS-glycoprotein (alpha 2HS-GP), as measured by the single radial immunodiffusion technique in the sera of 52 patients with various renal diseases and varying degrees of proteinuria, was found to be significantly reduced (P less than 0.001) when compared to the control values. Out of the 52 patients examined, 34 were found to excrete alpha 2HS-GP in urine with no correlation between the serum and urine levels of this protein. Although there is a statistically significant correlation between the clearances of albumin and alpha 2HS-GP, in only six patients were the clearances of alpha 2HS-GP within +/- 25% of albumin clearance. Twelve had higher, and 16 had lower, relative clearances of alpha 2HS-GP. The relative clearance of alpha 2HS-GP had no relation to the serum levels of alpha 2HS-GP, but correlated with the degree of proteinuria and the type of histological lesion in the kidney. In conclusion, there is a quantitative reduction of serum alpha 2HS-GP in patients with renal diseases. It appears that the degree of proteinuria and the type of renal lesion influences its selective handling by the kidneys.
Juvenile proximal spinal muscular atrophy with early hypertrophy of calves
Authors: Gobernado J M , Riva C , Gimeno A , García-Albea E , Anaya A
Published: December 2008

The clinical, electrophysiological, histological and ultrastructural features of a patient with chronic spinal muscular atrophy of adolescent onset associated with hypertrophied calf-muscle are described. This recently recognised entity must be distinguished from other types of spinal muscular atrophy.
Heparin-associated priapism
Authors: Burke B J , Scott G L , Smith P J B , Wakerley G R
Published: December 2008

A patient who developed priapism 7 hr after stopping an intravenous heparin infusion is described. Abnormal spontaneous platelet aggregation was demonstrated whilst on heparin treatment and is thought to play a role in the aetiology of heparin induced priapism.
Bullous skin eruption associated with carbamazepine overdosage
Authors: Godden David J , McPhie James L
Published: December 2008

A patient who developed a bullous skin eruption associated with carbamazepine overdosage is described. The authors believe this previously unreported phenomenon to be of clinical importance. Carbamazepine should be considered in the differential diagnosis of drug-induced coma with associated bullous lesions.
The treatment of quinine poisoning with charcoal haemoperfusion
Authors: Morgan Michael D L , Rainford David J , Pusey Charles D , Robins-Cherry A M , Henry J G
Published: December 2008

Quinine poisoning is rare but serious. Attempts at treatment by active removal have proved unsuccessful because of its high degree of protein binding. We describe two cases of non-accidental overdose of quinine (19.5 g and 15 g) with potentially fatal serum quinine levels. Both patients were treated by 2 periods of charcoal haemoperfusion during which quinine clearances of up to 125 ml/min were obtained. Both patients recovered, though one had some residual visual disturbance. We suggest that in cases of quinine poisoning, charcoal haemoperfusion may be a safe and effective method of drug removal, to be used with stellate ganglion block.
Review of general surgery 1982
Authors: Ellis Harold
Published: December 2008

Once again I have had the enjoyable task of preparing an annual review of General Surgery. Once again, it represents a digest of papers and books that I have found of particular interest and value during the last 12 months and it must therefore have the rather personal flavour of the author’s surgical hobbies.
Systolic time intervals: a review of the method in the non-invasive investigation of cardiac function in health, disease and clinical pharmacology
Authors: Hassan S , Turner P
Published: December 2008

Measurement of systolic time intervals is a valuable, non-invasive procedure to assess left ventricular performance, particularly when influenced by drugs. In this review, we discuss various factors affecting systolic time intervals, the therapeutic implications of the technique and its place among other non-invasive tests of cardiac function.
Acute cerebellar ataxia and infectious mononucleosis
Authors: Wadhwa N K , Ghose R R
Published: December 2008

A 28-year-old man, who presented with acute cerebellar ataxia, was found to have haematological features of infectious mononucleosis. There was serological evidence of recent infection with Epstein-Barr virus. It is speculated that cerebellar dysfunction results from virus-induced inflammatory changes within the central nervous system.
Thiazides, beta blockers and lipoproteins
Authors: Ballantyne D , Ballantyne F C
Published: December 2008

Beta blockers and thiazide diuretics are the most commonly used agents in the treatment of hypertension because of their efficacy and lack of side effects. It is hoped that by lowering blood pressure with these drugs the medium and long-term risk of coronary heart disease is reduced. The Veterans Administration Cooperative Group (1970) provided clear evidence of an effect on cerebrovascular disease morbidity and mortality, but a decrease in cardiac events was not proven. More recently, encouraging evidence of such a reduction in coronary heart disease mortality has been reported by the Hypertension Detection and Follow-up Program Cooperative Group (1979a, b). However, the authors considered that the data for cause of death were too unreliable to permit conclusions to be drawn. It therefore seems that therapy of hypertension is more effective in reducing cerebrovascular disease than coronary heart disease.
Left ventricular thrombi after acute myocardial infarction
Authors: Bhatnagar Sudhir K , Al Yusuf Abdul Razzak
Published: December 2008

Two-dimensional echocardiography was utilized in a prospective study to find the incidence, characteristics and natural history of left ventricular thrombus in 50 consecutive patients with acute myocardial infarction. The overall incidence of thrombosis was 14%; 19% in anterior and 5% in inferior infarction. The thrombus was detected at the apex in 4, along the ventricular septum in 2 and at both these sites in one patient. It was observed 3-10 days after the infarction.

Thrombus at the ventricular septum, seen in this study, has not been reported previously in acute myocardial infarction. Development of apical and septal thrombi was significantly associated with akinesis of these sites. Only 2 patients with protruding thrombi had systemic embolism.

We conclude that the apex as well as the septum are common sites for thrombosis in patients with severe wall motion abnormalities following acute anterior infarction. Careful observation of these sites during echocardiography may reveal thrombi prone for embolization.
Transient, selective factor X deficiency and acute liver failure following chest infection treated with erythromycin BP
Authors: Hosker J P , Jewell D P
Published: December 2008

A 57-year-old man developed symptoms of a respiratory tract infection which was treated with erythromycin BP. He subsequently went into acute liver failure. Investigation of a very prolonged prothrombin time revealed a marked, selective factor X deficiency (1% of normal activity). He later recovered virtually normal liver function and completely normal factor X activity.
Polyneuropathy in hypothyroidism
Authors: Dick D J , Lane R J M , Nogues M A , Fawcett P R W
Published: December 2008

A patient who developed symptoms and signs of a polyneuropathy was found to have hypothyroidism, though this diagnosis was not clinically suspected. Treatment with thyroxine resulted in resolution of his symptoms and restored his nerve conduction studies to normal.
Kingella kingae causing septic arthritis in Felty’s syndrome
Authors: Lewis D A , Settas L
Published: December 2008

A case of septic arthritis of the elbow caused by Kingella kingae, a Gram-negative bacillus, is described. The patient had long-standing, severe rheumatoid arthritis and Felty’s syndrome. This appears to be the first report from the United Kingdom of Kingella kingae as the aetiological agent of septic arthritis.
Fetus papyraceus—11 cases
Authors: Daw E
Published: December 2008

Eleven cases of the rare condition of fetus papyraceus are described and reviewed.
Factors affecting pain in burned patients—a preliminary report
Authors: Charlton J E , Klein R , Gagliardi G , Heimbach D M
Published: December 2008

Twenty-six patients in a burn unit were given the McGill Pain Questionnaire, Illness Behaviour Questionnaire, State-Trait Anxiety Inventory, Zung self-rating depression questionnaire and visual graphic rating scales of pain, depression and helplessness. Preliminary results indicate significant pain and anxiety related to procedures such as debridement, physiotherapy and skin-grafting. Depression occurred in one third of patients and was associated with prolonged stay in hospital and complicated surgical course. The instruments used in this study are suitable for assessing pain and factors affecting it.
Hypertension in the West Indies
Authors: Grell Gerald A C
Published: December 2008

Hypertension is the most common chronic disease in the West Indies, and is a major health problem today being among the 10 most common causes of death in the English-speaking territories of the region. Most patients have essential hypertension. Renal failure, stroke, and cardiac failure are the most common complications, myocardial infarction being relatively uncommon in black patients.

While an earlier report from the Caribbean suggested that beta-blockers were not effective for treating black hypertensives, recent experience with these drugs show that they are useful particularly when administered along with a diuretic. Beta-blockers may be required in higher doses than those commonly recommended for patients in Europe and North America, but even small doses of thiazide diuretics are effective in lowering the blood pressure of West Indian hypertensives.

West Indians show a combination of personalistic, naturalistic, and modern medical beliefs, which need to be understood in order to mount effective programmes for the management of hypertension in the community.
The pattern and severity of coronary artery disease in Asians and whites living in Birmingham
Authors: Lowry Patricia J , Mace P J E , Glover D R , Littler W A
Published: December 2008

Thirty-four Asian patients with coronary artery disease (CAD) were each matched for age, sex, blood pressure and duration of symptoms with 2 white patients with CAD. Blind assessment of coronary arteriograms demonstrated significantly more severe disease in Asians but distribution of disease was similar in both groups. Assessment of risk factors showed that the Asian group had significantly more non-smokers, lower cholesterol levels and weighed less than whites.
The ethnic prevalence of hypertension in a diabetic clinic
Authors: Pacy P J , Dodson P M , Beevers M , Fletcher R F , Taylor K G
Published: December 2008

Using the WHO criteria of hypertension, we have demonstrated that 40% of randomly selected diabetic clinic attenders under the age of 65 were hypertensive.

Black diabetics had a significantly greater prevalence (P less than 0.001) of hypertension than either white or Asian diabetics. Hypertension was commoner in black and white females compared with males (P less than 0.001); in Asians this difference was not statistically significant.

Systolic hypertension was the most common form in all ethnic groups. Only 38.7% of diabetics receiving antihypertensive therapy had normal blood pressure readings.

Blood pressure measurement should therefore be routinely performed in all diabetic patients under the age of 65, particularly in females of all ethnic groups and in black males.
The effects of a high fibre, low fat and low sodium dietary regime on diabetic hypertensive patients of different ethnic groups
Authors: Dodson P M , Pacy P J , Beevers M , Bal P , Fletcher R F , Taylor K G
Published: December 2008

Fifty-three diabetic patients with mild hypertension were allocated to a treatment diet with a high fibre, low fat and low sodium dietary regime or a control diet. After a 1-month treatment period, the modified-diet treated group (n = 35) showed a highly significant reduction in mean diastolic blood pressure (P less than 0.001) accompanied by significant reduction in urinary sodium excretion (P less than 0.01). The mean values of diastolic pressure (P less than 0.05) and urinary sodium/potassium ratio (P less than 0.01) were also significantly reduced at 1 month compared to control. White (n = 16) and West Indian (n = 10) diabetic hypertensive patients demonstrated a similar significant hypotensive response (P less than 0.05 and less than 0.01 respectively) with reduction in urinary sodium excretion to the modified diet. In contrast, Asian patients demonstrated no significant changes.

Treatment of hypertension in diabetic subjects with a high fibre, low fat and low sodium dietary regimen may have a hypotensive response after a period of 1 month and there is a similar response in both black and white ethnic groups. Further observation of these patients will determine long-term response and compliance.
Ethnic differences in the distribution of congenital malformations
Authors: Terry P B , Mathew P M , Condie R G , Bissenden J G
Published: December 2008

Major lethal and non-lethal congenital malformations occurring in babies born in Dudley Road Hospital in 1979, 1980 and 1981 were related to the ethnic group of the mother. There was an increased incidence of gastrointestinal malformations in the Indian group and an increased incidence of abnormalities that could be associated with consanguinity and increased maternal age in the Pakistani group.

A sample population (2000 mothers) was obtained in the first 7 months of 1982 to determine the maternal age distribution and consanguinity rates in the various ethnic groups.
Inner-city residents, ethnic minorities and primary health care
Authors: Johnson M R D , Cross M , Cardew S A
Published: December 2008

Ethnic minorities form a substantial proportion of the urban population. A household survey in the West Midlands assessed usage of primary and preventative health care services. Asian households made some-what higher use of general practitioner (GP) facilities which can be related to demographic and socio-economic status. Fewer differences were found than expected, and uptake of preventative services was good. Afro-Caribbean patterns were similar to those of whites.
Nutritional disturbances in Crohn’s disease
Authors: Harries A D , Heatley Richard V
Published: December 2008

A wide range of nutritional disturbances may be found in patients with Crohn’s disease. As more sophisticated tests become available to measure vitamin and trace element deficiencies, so these are being recognized as complications of Crohn’s disease. It is important to recognize nutritional deficiencies at an early stage and initiate appropriate treatment. Otherwise many patients, experiencing what can be a chronic and debilitating illness, may suffer unnecessarily from the consequences of deprivation of vital nutrients.
Basal cell carcinoma—a review of treatment results with special reference to cryotherapy
Authors: McIntosh G S , Osborne D R , Li A K C , Hobbs K E F
Published: December 2008

A retrospective study has been undertaken of all head and neck basal cell cancers treated at the Royal Free Hospital between 1976 and 1980 inclusive.

Four methods of treatment were used during the period: simple excision with primary closure (n = 43), skin grafting or trans-position flap (n = 19), radiotherapy (n = 99), and cryosurgical ablation (n = 34). The methods were compared by observing the immediate results, the subsequent tumour recurrence rate and the length of follow-up.

Statistical comparison of tumour recurrence rate showed no significant difference between treatment groups. Radiotherapy had the lowest recurrence rate (2%), but required an average of 9 out-patient treatment attendances. Excision with primary closure carried the highest recurrence rate (9.3%), whilst excision with defect closure by flap or graft, which needed a mean in-patient stay of 8.2 days, and cryosurgical treatment had similar recurrence rates of 5 to 6%. Comparing the modes of treatment, cryosurgery was quickest to perform, required no hospitalization and less than 2 out-patient treatment sessions per patient and gave the best cosmetic result. It appears to be a safe technique for treating basal cell cancers and may prove to be the most cost effective method.
Renal lesions in leprosy amongst north Indian patients
Authors: Chugh K S , Damle P B , Kaur S , Sharma B K , Kumar B , Sakhuja V , Nath I V S , Datta B N
Published: December 2008

Sixty consecutive patients with leprosy were investigated for renal involvement. Clinically overt renal disease was present in 4 patients; 3 presented with a nephrotic state and one patient with progressive renal failure. Urinalysis showed daily protein loss ranging from 0.4 to 8.9 g in 8 patients and microscopic haematuria in 4 cases. Elevated levels of blood urea and creatinine were seen only in one patient with diffuse proliferative glomerulonephritis. Of the 36 patients in whom distal tubular functions were evaluated, concentration and/or acidification defects were detected in 9 patients (25%). Renal histology revealed no abnormality in any of these patients. Serum C3 levels were decreased in 5 patients with lepromatous leprosy and 3 patients with borderline leprosy.

Histological evidence of renal involvement was detected in 9 patients (15%). Amyloid deposits were seen in 3 (5%) patients of whom 2 had lepromatous leprosy and one had tuberculoid leprosy with chronic trophic ulcers. Mesangial proliferative lesions were seen in 5 (8.3%) and diffuse proliferative lesions (with crescents in more than 70% of glomeruli) in one patient. All of them had lepromatous leprosy. Three of the 5 patients with mesangial proliferative glomerulonephritis had erythema nodosum leprosum at the time of biopsy. Immunofluorescence studies revealed granular deposits of IgA, IgM and C3 in one patient with mesangial proliferation and IgA/IgM with or without C3 in 3 more patients in whom renal histology was normal. Glomerulonephritis associated with leprosy appears to be immune mediated but confirmation requires identification of lepra antigen in the glomerular immune complex deposits.
‘Hospice’ versus ‘hospital’ care—re-evaluation after 10 years as seen by surviving spouses
Authors: Parkes C. Murray , Parkes Jenny
Published: December 2008

This study compares terminal cancer care in 1967–69 with care in 1977–79 as evaluated by surviving spouses of patients who died in St Christopher’s Hospice and other local hospitals.

Patients and their surviving spouses reported less personal distress in both settings in 1977–79 than in 1967–69 and the patients were also thought to have suffered less pain. These differences were found before, during and, in surviving spouses, after the period of terminal care. They were confirmed in subsamples of 30-34 patients matched for age, sex, socio-economic status and duration of terminal period.

Improvements may be attributable to the training in terminal care provided by staff of the Hospice since 1967 and augmented in its Study Centre which was opened in 1973.

Although pain and distress in the patient is no longer a major problem in either setting, spouses in 1977–79 remain less anxious at St Christopher’s Hospice than at other hospitals; they play a larger part in the care of the patient and are in closer contact with staff before and after bereavement.
Captopril in hypertension after renal transplantation
Authors: Chan M. K. , Sweny P. , El Nahas A. M. , Farrington K. , Fernando O. N. , Moorhead J. F.
Published: December 2008

Eight hypertensive renal allograft recipients who had received captopril are presented. Captopril in a maximal daily dose of 250 mg enabled the withdrawal of large doses of beta-blocking agents and vasodilators. Blood pressure was satisfactorily controlled in all except one. No adverse side effects were observed other than the 'first dose' effect which resulted in transient anuria in one patient. Captopril appears to be a useful agent in the management of severe hypertension after renal transplantation.
Dermatobia hominis infestation
Authors: Nunzi E. , Rongioletti F. , Rebora A.
Published: December 2008

A patient is reported who, after leaving Venezuela, developed some boils on the left upper limb inhabited by Dermatobia hominis larvae. The curious life-cycle of this tropical fly is described with some considerations about the diagnostic problem. A simple unreported way of larvae extraction is suggested.
Oral disopyramide after admission to hospital with suspected acute myocardial infarction. U. K. Rythmodan Multicentre Study Group
Authors: Rythmodan U. K.
Published: December 2008

A multi-centre double-blind randomized study is reported in which the effect on mortality of oral disopyramide (300 mg loading dose, then 100 mg qds) was compared with placebo in 1985 patients entering hospital with suspected acute myocardial infarction. Treatment was commenced with 24 hr of onset of symptoms (mean time to first dose 9 hr) and continued until discharge from hospital or 14 days, whichever came first. Nine-hundred and ninety-five patients were allocated to disopyramide and 990 to placebo. The overall mortality, calculated on an intention-to-treat basis, was 7.2% for the disopyramide and 5.6% for the placebo patients. Among those patients with proven infarction mortality was 9.5% of 687 on disopyramide and 7.4% of 716 on placebo. These differences are not statistically significant. Patients with cardiac failure or hypotension at entry did not fare worse on disopyramide, but those with a conduction defect did. Reinfarction was not significantly influenced by disopyramide. The prophylactic use of disopyramide in patients with suspected acute myocardial infarction does not reduce mortality or the incidence of early reinfarction.
Hypnosis in the treatment of acute pain in the emergency department setting
Authors: Deltito Joseph A.
Published: December 2008

Emergency ward physicians are presented daily with patients in pain. Provisions of safe, quick pain control remains one of their major duties. Hypnosis can be used as an effective adjunct or substitute for analgesic medications when these drugs prove to be ineffective or contraindicated. Four such illustrative cases of attempted pain control are presented. The psychological foundations of pain and its assessment are discussed.

The emergency ward physician can obtain facility in hypnotic techniques with only modest training. Hypnosis may then become a valuable tool in helping him provide safe and effective pain management.
Salmonella meningitis following treatment of enteritis with neomycin
Authors: Hardy C. , Bansal A. , Lowes J. A. , George C. F.
Published: December 2008

A case of salmonella meningitis with accompanying septicaemia and pericarditis is reported in an adult following an episode of enteritis.
Dementia due to tumours of the corpus callosum
Authors: Harrison M. J. G.
Published: December 2008

The clinical features of 16 cases of tumours of the corpus callosum are described. Many presented with mental changes which were eventually obvious in all but one of the patients. The need to consider these tumours in the differential diagnosis of dementia is discussed.
Chest pain—indigestion or impending heart attack?
Authors: Simpson F. G. , Kay Janet , Aber Clive P.
Published: December 2008

A high proportion (40%) of patients with definite myocardial ischaemia who were questioned on admission to a Cardiac Monitoring Unit had experienced preceding chest pain which had been misinterpreted by both the patients themselves and doctors as ‘indigestion’ and which had often been inappropriately treated. ‘Indigestion’ in the chest in previously non-dyspeptic subjects over 40 years of age should be regarded as myocardial ischaemia until proved otherwise.
Cricoid webs—incidence and follow-up study in Indian patients
Authors: Khosla S. N.
Published: December 2008

A study was conducted to investigate the association of anaemia with dysphagia and cricoid webs in an adult Indian hospital population of 2,840 patients (1,200 males and 1,640 females).

There were 150 cases (5.2%) of anaemia in the total population studied. One hundred and seventeen patients suffered from iron deficiency anaemia and only 33 from non-iron deficiency anaemia. Dysphagia was present in 15 patients (13%) of those with iron deficiency. Six (40%) of these cases of iron deficiency with dysphagia had cricoid webs.

None of the cases with non-iron deficiency anaemia or the control population had either dysphagia or cricoid webs.

Iron therapy improved four out of the six patients of iron deficiency with cricoid webs both subjectively and objectively.
Clinical comparison of elastic supports for venous diseases of the lower limb
Authors: Gandhi D. B. , Palmar J. R. , Lewis B. , Schraibman I. G.
Published: December 2008

Compression garments for the lower limb were tested in two groups—general support garments and anti-embolism supports. A total of 98 patients was examined. The method used was by the interposition of partly fluid-filled pressure sensors between garment and skin. A combination of roller bandage with shaped tubigrip (SBB—Seton) and Sigvaris stockings afforded effective pressure in the general support group but only the roller bandage plus pressure garment (Seton) did so in the anti-embolism group, both in the acute and prolonged studies.
Strangulated stomach within a femoral hernia
Authors: Cade Richard J. , Lane Robert H. S.
Published: December 2008

A complication of femoral hernia not previously described, namely gastric strangulation, is reported.
A comparison of beclomethasone dipropionate aqueous nasal spray and beclomethasone dipropionate pressurized nasal spray in the management of seasonal rhinitis
Authors: Dunn A. M. , Wilson R. S. E. , Baggott P. J.
Published: December 2008

Forty patients with seasonal rhinitis and a proven sensitivity to pollens were studied for 2 weeks during the pollen season of 1982. The study was carried out according to a double-blind, double-dummy design. All patients received 100 micrograms beclomethasone dipropionate (BDP) into each nostril twice daily (400 micrograms/day) on a randomized basis, from either the aqueous nasal spray or the pressurized nasal spray (Beconase Nasal Spray). Analysis of patients’ symptom scores, additional symptomatic medication and physicians’ assessment indicated that both treatments were equally effective in controlling the symptoms of seasonal rhinitis. Any adverse events reported were considered to be clinically insignificant.

BDP aqueous nasal spray was therefore found to be an effective and acceptable therapy in the management of seasonal rhinitis.
Severe heparin osteoporosis in pregnancy
Authors: Griffiths H. T. , Liu D. T. Y.
Published: December 2008

A case of severe osteoporosis following administration of low dose subcutaneous heparin in pregnancy is reported. Possible reasons for the condition are suggested which caution against the indiscriminate use of subcutaneous heparin in pregnancy.
Human infestation by Taenia saginata lasting over 20 years
Authors: Wright E. P. , Jain S.
Published: December 2008

A case of a 61-year-old woman with a history of infestation by Taenia saginata lasting over 20 years is described. The patients repeatedly denied eating raw or inadequately cooked beef. Despite many attempts using different taenicides during those years, the patient continued to pass tapeworm segments until niclosamide was administered. Eighteen months after treatment with niclosamide the patient remains symptom-free.