bluuebunny/crossref_metadata_2025 huggingface dataset:
Intestinal ischaemia associated with phaeochromocytoma
Authors: Carr N D , Hulme A , Sheron N , Lees W R , Russell R C G
Published: December 2008

The present case report describes a patient with an adrenal phaeochromocytoma who presented with infarction of the small intestine. The clinical features, diagnosis and treatment of this case are described. Despite excision of the tumour and necrotic intestine, this patient died in the postoperative period from overwhelming sepsis and multi-organ failure. Special reference is made to the delayed effects of established intestinal ischaemia on immune function and it is suggested that this was major contributory factor to the fatal outcome in the present case. The onset of gastro-intestinal symptoms in patients with phaeochromocytoma should suggest the possibility of imminent gut ischaemia and indicate the necessity for prompt excision of the tumour.
Attitudes of hospital doctors in Wales to use of intravenous fluids and antibiotics in the terminally ill
Authors: Marin P P , Bayer A J , Tomlinson A , Pathy M S J
Published: December 2008

Decisions concerning the use of intravenous fluids and antibiotics in terminally ill patients are regularly made by hospital doctors, but there is little record of staff attitudes and current practice in Britain. A questionnaire was therefore distributed to 833 Welsh hospital doctors, citing the case of a hypothetical terminally ill patient and asking questions about medical management. Of the 448 (54%) doctors who replied, 346 (77%) had managed a similar patient recently. Intravenous fluids would be administered by 238 (53%), with 206 of these (87%) resiting the cannula as required and 62 (26%) resorting to a central venous line if there was no alternative. With increasing age and seniority doctors become conservative in their approach. Nearly all claimed that ‘ensuring the patient’s comfort’ was the reason for their decision. Only 72 (16%) would use antibiotics if the patient became pyrexial.

The results suggest that British doctors are divided in their approach to the medical management of terminally ill patients and there is a need for greater discussion and training so that all the issues involved are fully appreciated.
Single central nervous system lesions can simulate multiple sclerosis
Authors: Grosset D G , Hadley D M , Bone I
Published: December 2008

Three cases are reported in which an initial misdiagnosis of multiple sclerosis was made. In each of these a single central nervous system lesion with space occupying effect was present. These lesions caused confusion because multiple closely running neurological tracts were affected, and there was relapse and remission in the neurological signs and symptoms produced. We conclude that such cases need careful assessment to determine whether a single structural lesion could explain the presentation. Early imaging may show remediable lesions or prevent unnecessary steroid therapy.
Intermittent absorption of warfarin caused by an unrecognized pharyngeal pouch
Authors: Ong A , Slater J D H
Published: December 2008

An 80 year old woman on long term warfarin presented with an acute haemarthrosis of her right knee. Further investigations revealed a large pharyngeal pouch and a history of tablet regurgitation was obtained. Surgical resection was necessary 12 months later to ensure predictable absorption of orally administered drugs. The varying presentation of pharyngeal pouches and the importance of this complication are discussed.
Infected atrial myxoma
Authors: Chow W H , Chow L , Cheung K L , Lee J , Khin A
Published: December 2008

A patient is reported in whom a left atrial myxoma was found to be infected with Staphylococcus aureus. The clinical presentation, diagnosis and treatment are described and discussed.
Renal embolization for ablation of function in renal failure and hypertension
Authors: Millard F C , Hemingway A P , Cumberland D C , Brown C B
Published: December 2008

The results of transcatheter renal artery embolization are presented in a small group of patients with end-stage renal disease. Five of the patients were suffering from severe drug-resistant hypertension, one from rejection of a renal transplant and one had heavy haematuria from a transplant kidney. All seven patients benefited from the procedure with no significant morbidity. The procedure of renal artery embolization and its potential complications are discussed. It is concluded that renal ablation by transcatheter embolization is not only effective, but also has a significantly lower morbidity and mortality than surgical nephrectomy in this group of patients with end-stage renal disease and associated problems.
Colchicine cardiotoxicity following ingestion of Gloriosa superba tubers
Authors: Mendis S
Published: December 2008

The clinical features of colchicine toxicity in a patient following ingestion of Gloriosa superba tubers are described. Gastroenteritis, acute renal failure, cardiotoxicity and haematological abnormalities were the main toxic manifestations. There was no hypotension and no neurological manifestations. Electrocardiographic changes were noteworthy and have not been reported previously.
Does a common pathophysiological basis exist in the association of ulcerative colitis and Takayasu’s aortitis? Report of a case
Authors: Ikenaga H , Ogihara T , Iyori S , Kou S , Yoshikawa H , Okura M M
Published: December 2008

A case of a young Japanese woman with long-standing ulcerative colitis complicated by preinfarction angina due to Takayasu’s aortitis is presented. Successful emergency aorto-coronary bypass operation was performed. Whether the association of these two diseases can be explained by a common mechanism is discussed.
Sarcoidosis presenting with an acute Guillain-Barré syndrome
Authors: Miller R , Sheron N , Semple S
Published: December 2008

A 28 year old Caucasian male presented with an acute Guillain-Barré syndrome and bilateral facial weakness. He had an abnormal chest radiograph. Lumbar puncture revealed acellular fluid with a raised protein count and lung function tests showed a restrictive ventilatory defect. The patient deteriorated and required mechanical ventilation for 14 days. Steroids and plasmapheresis were not used and the patient spontaneously recovered. Two months after presentation limb power was almost normal but there was residual partial bilateral facial weakness. The chest radiograph remained abnormal and repeat lung function tests showed a persistent restrictive ventilatory defect and a reduced gas transfer coefficient. A transbronchial biopsy revealed non-caseating granulomata. The association between neurosarcoidosis and Guillain-Barré polyneuropathy is discussed and the literature reviewed.
Retroperitoneal lymphadenopathy in familial Mediterranean fever
Authors: Rimon D , Meir Y , Cohen L
Published: December 2008

Peripheral lymphadenopathy is rarely observed, whereas mesenteric lymphadenopathy is found occasionally on laparotomies in patients with familial Mediterranean fever (FMF). Retroperitoneal lymphadenopathy was reported only once in an autopsy of a patient with FMF. Our case is the second one, and the first one to be diagnosed during life, by means of abdominal ultrasonography and computerized tomography. In patients with FMF, where lymph node biopsy was done, the pathological finding was non-specific lymphoid hyperplasia.
Endobronchial polyp and chronic smoke injury
Authors: Smith R E
Published: December 2008

A case of an inflammatory endobronchial polyp associated with chronic smoke injury is reported. Unlike previously reported cases, this was not associated with acute, severe thermal injury, was solitary in occurrence, and responded rapidly to a short course of intrabronchial steroids.
Paraquat poisoning: per vagina
Authors: Ong M L , Glew S
Published: December 2008

We describe a fatal case of paraquat poisoning as a result of per vaginal contact with the herbicide. Death occurred 18 days later from hepatic, renal and respiratory failure.
Camel bites: report of severe osteolysis as late bone complications
Authors: al-Boukai A A , Hawass N E D , Patel P J , Kolawole T M
Published: December 2008

Four cases of severe osteolysis of bones subsequent to camel bite are described. The first had osteolysis of the ribs with traumatic diaphragmatic hernia. Two cases had similar appearances of gross osteolysis of the shafts of the radius and ulna, whilst one had osteolysis of the humeral shaft. The similarities in the radiological appearances especially of the gross osteolysis at the site of trauma are noted. The complications following mammal bites are discussed.
Hepatic abnormalities in coeliac disease: three cases of delayed diagnosis
Authors: Mitchison H C , Record C O , Bateson M C , Cobden I
Published: December 2008

Three cases of biopsy-proven coeliac disease are presented. In each case the predominant clinical and laboratory features suggested liver disease, bowel symptoms were a minor part of the presentation and the diagnosis of coeliac disease was not reached for approximately 6 months. Liver biopsy in one case showed marked fatty change, in the other cases only mild hepatitic changes. A gluten-free diet produced resolution of symptoms and, in the patient with steatosis, normalization of liver function tests. Hepatic abnormalities have been reported in coeliac disease and the significance of these is discussed but such abnormalities are usually minor and do not obscure the underlying diagnosis. We feel that these cases serve as a salutary reminder of the protean manifestations of coeliac disease.
Hyperostosis frontalis interna, acromegaly and hyperprolactinaemia
Authors: Fulton J D , Shand J , Ritchie D , McGhee J
Published: December 2008

The association between hyperostosis frontalis interna (HFI), acromegaly and hyperprolactinaemia was investigated. Thirty six acromegalic patients, of whom 19 had hyperprolactinaemia, were compared with 36 randomly-selected, age-sex matched controls. There was a higher prevalence of HFI in the skull X-rays of the acromegalic cohort (P = 0.0002) when compared to the control group. This difference was apparent in both men (P = 0.01) and women (P = 0.01). Acromegalic patients with hyperprolactinaemia also expressed HFI in a higher proportion of individuals than the control group (P = 0.0001). Intra- and interobserver variability was assessed and concordance with 100% and 97% in the moderate and severe HFI sub-groups. The following sub-group analysis was undertaken: acromegalics and those acromegalics with hyperprolactinaemia were compared with the controls and a highly significant distinction was confirmed (P = 0.0007 and P = 0.00001 respectively). A relationship between HFI severity and the patient's age was noted in both male and female acromegalics. Also, the severity of HFI appeared related to disease duration in female acromegalics.

The cause of HFI remains unknown but appears to be strongly associated with acromegaly, particularly in the presence of co-existent hyperprolactinaemia. The association may have symptomatic significance and the presence of HFI should be confirmed or refuted in all patients with acromegaly.
Intra-operative blood glucose and serum insulin concentrations in the surgical management of insulinoma
Authors: Krentz A J , Hale P J , Baddeley R M , Williams A C , Natrass M
Published: December 2008

The surgical management of insulinoma is frequently complicated by difficulty in pre- and intra-operative localization of the tumour. An early and reliable post-operative indicator of successful surgery would therefore be useful in the management of this condition.

In a prospective, controlled study serial measurements of blood glucose and serum insulin concentrations were performed in 5 patients with insulinoma during surgical removal of the tumour. Results were compared with 5 patients, matched for age and body weight, undergoing abdominal surgery for non-malignant disease. Serum insulin (mean ± s.e.m.) was significantly elevated in the insulinoma patients at the start of surgery (32.1 ± 3.1 vs 6.1 ± 2.2 mU/l; P < 0.01). A significant fall (P < 0.01) to levels comparable with the control patients (7.5 ± 1.8 vs 10.0 ± 3.3 mU/l) occurred following removal of the tumour. We conclude that serial intra-operative measurements of serum insulin concentration are technically simple to perform and provide useful retrospective corroboration of successful surgery in patients with insulinoma.
Fatal Lyme carditis and endodermal heterotopia of the atrioventricular node
Authors: Cary N R B , Fox B , Wright D J M , Cutler S J , Shapiro L M , Grace A A
Published: December 2008

A fatal case of Lyme carditis occurring in a Suffolk farmworker is reported. Post-mortem examination of the heart showed pericarditis, focal myocarditis and prominent endocardial and interstitial fibrosis. The additional finding of endodermal heterotopia (‘mesothelioma’) of the atrioventricular node raises the possibility that this could also be related to Lyme infection and account for the relatively frequent occurrence of atrioventricular block in this condition. Lyme disease should always be considered in a case of atrioventricular block, particularly in a young patient from a rural area. The heart block tends to improve and therefore only temporary pacing may be required.
Duodenal ulceration into the cystic artery
Authors: Ford G A , Simpson A H R W , Gear M W L , Wilkinson S P
Published: December 2008

We report two cases of massive gastrointestinal bleeding due to anterior duodenal ulceration into the cystic artery, with gallbladder infarction as a complication. These cases indicate the potential dangers of laser therapy or embolization in bleeding anterior duodenal ulcers penetrating the cystic artery, as such therapy will arrest blood flow through the cystic artery and may precipitate gallbladder infarction.
The cardiovascular effects of beta adrenergic agonist drugs administered by nebulisation
Authors: Flatt A , Crane J , Purdie G , Kwong T , Beasley R , Burgess C
Published: December 2008

The cardiovascular effects of equal doses (5 mg) of nebulised fenoterol, salbutamol and terbutaline were compared in 12 healthy individuals in a double-blind, placebo-controlled study. Measurements of heart rate, blood pressure, systolic time intervals, QTc interval and T-wave amplitude were made at baseline and at 15, 30, 45, 60 and 90 minutes after nebulisation. Fenoterol caused significantly greater chronotropic electrocardiographic and inotropic effects than either salbutamol or terbutaline. The peak effects after terbutaline occurred later than those after fenoterol or salbutamol.
Enema or Picolax as preparation for flexible sigmoidoscopy?
Authors: Hickson D E G , Cox J G C , Taylor R G , Bennett J R
Published: December 2008

Two preparations for outpatient flexible sigmoidoscopy, Picolax and Klyx enemas, have been compared in a randomized controlled trial. There was no difference in efficacy between the two preparations, but patients preferred Picolax.
Coeliac disease and collagenous colitis
Authors: O'Mahony S , Nawroz I M , Ferguson A
Published: December 2008

We describe a case of collagenous colitis in a young man with coeliac disease who had responded clinically and histologically to a gluten-free diet three years previously. The collagenous colitis responded initially to oral corticosteroid therapy and he is now asymptomatic (and with normal rectal mucosa) on oral mesalazine. Collagenous colitis should be considered in the coeliac patient with diarrhoea despite adherence to a gluten-free diet.
Haemostasis in hypothyroidism
Authors: Ford H C , Carter J M
Published: December 2008

Abnormalities that have been reported for platelet indices and function, coagulation factors and tests, and the fibrinolytic system in hypothyroidism are reviewed. These abnormalities, although usually of limited importance clinically, may occasionally lead to major bleeding episodes and to diagnostic confusion.
Focal fatty infiltration of the liver mimicking metastatic disease
Authors: Bashir Y
Published: December 2008

We report the mistaken diagnosis of metastatic liver disease by ultrasonography in a patient with congestive heart failure and focal fatty infiltration of the liver. Multiple echogenic space-occupying lesions in the liver can be caused by benign conditions as well as tumour deposits and in a debilitated patient the possibility of focal fatty infiltration should always be considered.
Spinal cord dysfunction complicating meningococcal meningitis
Authors: Khan J , Altafullah I , Ishaq M
Published: December 2008

A 29 year old male developed paraplegia during the acute phase of meningococcal meningitis. Possible mechanisms for this unusual complication are discussed and the literature regarding spinal cord complications of pyogenic meningitis is reviewed.
Pyoderma gangrenosum associated with erythroid hypoplasia
Authors: Wong C K , Pun K K , Lum C C M , Lee S W , Ng M M T , Wang C C L
Published: December 2008

Pyoderma gangrenosum is most commonly associated with inflammatory bowel disease and rheumatoid arthritis, but it has been associated with various haematological malignancies. We describe its association with primary erythroid hypoplasia without thymoma in an 80 year old woman who presented with septicaemia complicating urinary tract infection. Spontaneous healing of an extensive lesion was observed.
Weber-Christian disease producing splenic vein occlusion and bleeding gastric varices: successful treatment with sclerotherapy
Authors: Heseltine D , Bramble M , Cole A , Clarke D , Castle W
Published: December 2008

A 48 year old woman with intra-abdominal Weber-Christian disease presented with bleeding gastric varices and evidence of splenic vein occlusion. We describe the problems encountered in making this diagnosis and subsequent treatment.
Adverse effect of topical methylsalicylate ointment on warfarin anticoagulation: an unrecognized potential hazard
Authors: Yip A S B , Chow W H , Tai Y T , Cheung K L
Published: December 2008

The adverse effect of topical methylsalicylate ointment on warfarin anticoagulation is studied in 11 patients. All patients had an abnormally elevated international normalized ratio after significant usage of topical methylsalicylate ointment as obvious from both the clinical history and a positive blood level of salicylate. Out of the 11 patients, 3 had bleeding manifestation; 2 with bruises and 1 with gastrointestinal bleeding. It is concluded that topical methylsalicylate ointment should be prescribed with care to patients on warfarin and excessive usage is to be avoided since potentially dangerous drug interaction could occur.
A critical look at nursing observations
Authors: Burroughs Janet , Hoffbrand B I
Published: December 2008

Our experience has suggested that not only do nurses on hospital wards waste time making too many unnecessary clinical observations, but that it is very difficult to persuade them to modify the pattern of their practice.

We therefore conducted a survey by questionnaire among trained nurses in one health district of their everyday ward practice and attitudes to clinical observations. This showed that whilst a majority of nurses questioned believe in the importance of routine observations for patient care, there is a lack of consistency in the criteria and communication procedures used that must seriously limit the value of the information obtained by the individual nurse.

We believe that uncritical faith in routine observations is a barrier to rationalizing procedures to optimize efficient use of the professional skills of ward nurses in this regard. There is need for more thought to be given to the problem and in particular it is important that doctors play a more active role in decision making.
Facial nerve palsy associated with underwater barotrauma
Authors: Whelan T R
Published: December 2008

This report describes a case of facial nerve palsy following barotitis media sustained at shallow depth. The neuropraxia is likely to have been due to the direct effect of pressure, facilitated by a congenital hiatus in the bony canal protecting the facial nerve in the middle ear.
Cat-scratch disease presenting as the oculoglandular syndrome of Parinaud: a report of two cases
Authors: Jawad A S M , Amen A A A
Published: December 2008

We report the case histories of a 50 year old man and 14 year old daughter who presented with the oculoglandular syndrome of Parinaud caused by cat-scratch disease.
Successful late treatment of venous air embolism with hyperbaric oxygen
Authors: Dunbar E M , Fox R , Watson B , Akrill P
Published: December 2008

A case of haemodialysis-associated venous air embolism is described. The patient commenced hyperbaric oxygen therapy 21 hours after the event when, despite appearing decerebrate, he made a complete recovery. This case underlines the importance of all clinicians being aware of those centres with facilities for hyperbaric therapy and the need to refer all patients with cerebral air embolism even following a prolonged delay.
Primary plasmacytoma of the thyroid
Authors: Chesyln-Curtis S , Akosa A B
Published: December 2008

Primary plasmacytoma of the thyroid is a very rare tumour. We report a case and emphasize the importance of excluding multiple myeloma which may present as an extramedullary plasmacytoma. Histological diagnosis has been simplified by the use of immunohistochemical techniques.
Myalgic encephalomyelitis—a persistent enteroviral infection?
Authors: Dowsett E G , Ramsay A M , McCartney R A , Bell E J
Published: December 2008

Myalgic encephalomyelitis is a common disability but frequently misinterpreted. Amongst 6,000 patients referred for general microbiological diagnosis between 1975 and 1987, 420 cases were recognized. Coxsackie B neutralization tests, in 205 of these, demonstrated significant titres in 103/205 (50%), while of 124 additionally investigated for enteroviral IgM, 38/124 (31%) were positive. This illness is distinguished from a variety of other post-viral states by an unique clinical and epidemiological pattern characteristic of enteroviral infection. Prompt recognition and advice to avoid over-exertion is mandatory. Routine diagnosis, specific therapy and prevention, await further technical advances.
Lornoxicam, indomethacin and placebo: comparison of effects on faecal blood loss and upper gastrointestinal endoscopic appearances in healthy men
Authors: Warrington S J , Debbas N M , Farthing M , Horton M , Johnston A , Thillainayagam A , Turner P , Ferber H
Published: December 2008

Forty-five healthy men aged 21–34 years took part in a double-blind, parallel-group, placebo-controlled study of the effects of 28 days' treatment with lornoxicam 4 mg twice daily or indomethacin 50 mg twice daily on faecal blood loss and the endoscopic appearances of gastric and duodenal mucosa. After an initial endoscopic examination, subjects received, intravenously, on day 0, autologous erythrocytes labelled with 51Cr. Complete daily faecal collections were then made from days 6–12, 20–26 and 34–40. The drug treatments or placebo were given from days 13–41. Faecal blood loss was calculated from 51Cr-specific activity of blood and faeces. Endoscopy was repeated 4–8 hours after the last dose of medication; mucosal appearance was graded on a 5-point scale.

Lornoxicam caused no more adverse events than placebo; indomethacin caused more indigestion and central nervous system effects, and one subject in this group was withdrawn from the study. Median total blood losses during the pre-treatment and the second and fourth weeks of treatment were respectively 3.33, 3.95 and 5.71 ml for lornoxicam, 2.87, 7.04 and 7.75 ml for indomethacin, and 4.55, 3.64 and 4.13 ml for placebo. Differences between treatments were not statistically significant (P = 0.081 for second week of treatment, P = 0.383 for fourth week of treatment; Kruskal-Wallis test).

The effect of chlortenoxicam on faecal blood loss in this study was thus intermediate between placebo and indomethacin, but within- and between-subject variability was such that the differences were not statistically significant. Endoscopic findings were normal in most subjects before and after all treatments, but indomethacin was associated with a slightly greater deterioration in endoscopic score and was the only treatment associated with Grade 3 appearance (in a single patient) in post-treatment endoscopy.
Pulmonary infiltrates and fever induced by isoniazid
Authors: Salomaa E R , Ruokonen E-L , Tevola K , Tala E
Published: December 2008

An 88 year old woman with bacteriologically confirmed pulmonary tuberculosis was first treated with isoniazid, rifampicin and pyrazinamide. Two weeks later she developed pulmonary infiltrates with fever. A drug-induced reaction was suspected but the reaction recurred three times until isoniazid was identified as the cause. The reaction became worse each time, finally being nearly fatal.
Specialized gastrointestinal units for the management of upper gastrointestinal haemorrhage
Authors: Sanderson J D , Taylor R F , Pugh S , Vicary F R
Published: December 2008

In 1986, 292 patients were admitted to a joint medical-surgical gastrointestinal unit with upper gastrointestinal haemorrhage. Fourteen patients died (4.8%) a mortality considerably lower than recorded in most series. The low mortality may result from the use of a specialized gastrointestinal unit to which all patients with upper gastrointestinal haemorrhage are admitted and managed with strict protocols for resuscitation, transfusion and surgery.
Chronic bronchial suppuration and antineutrophil cytoplasmic antibody (ANCA) positive systemic vasculitis
Authors: Sitara D , Hoffbrand B I
Published: December 2008

Two patients with long-standing chronic bronchial suppuration developed antineutrophil cytoplasmic antibody (ANCA) positive Wegener's granulomatosis and microscopic polyarteritis respectively. There is published evidence of an association between previous suppurative respiratory disease and Wegener's granulomatosis. We believe that our cases provide further evidence that chronic lung infection may play an aetiological role in the development of ANCA-positive systemic necrotizing vasculitis in some individuals.
Primary non-Hodgkin's lymphoma of liver with humoral hypercalcaemia
Authors: Santhosh-Kumar C R , Ajarim D S , Shipkey F D
Published: December 2008

A case of primary non-Hodgkin's lymphoma of the liver with associated humoral hypercalcaemia is described. The patient was successfully treated with combination chemotherapy. A similar association has not been reported previously.
Gastric antral vascular ectasia (watermelon stomach)—therapeutic options
Authors: Park R H R , Danesh B J Z , Upadhyay R , Howatson A G , Lee F D , Russell R I
Published: December 2008

We have encountered five cases of chronic iron deficiency anaemia due to bleeding from gastric antral vascular ectasia (watermelon stomach). Two cases were associated with a lymphoma and in three cases there was evidence of portal hypertension. Two patients were treated conservatively by blood transfusions. The other patients required either surgery or tranexamic acid or endoscopic laser therapy to control the chronic haemorrhage.
Mitral valve prolapse and occult aortic coarctation
Authors: Ludman P , Yacoub M , Dancy M
Published: December 2008

A 22 year old man developed symptoms of left ventricular failure secondary to atrial fibrillation and congenital mitral regurgitation. After operation for mitral valve repair he was unable to be successfully weaned from cardiopulmonary bypass and this was ascribed to poor left ventricular function. He therefore underwent emergency cardiac transplantation but again was unable to be weaned from bypass. At post-mortem examination a previously undiagnosed aortic coarctation was revealed.

The presentation of occult aortic coarctation is discussed, and its association with congenital mitral valve abnormalities reviewed.
Small bowel obstruction with multiple perforations due to enterolith (bezoar) formed without gastrointestinal pathology
Authors: Salim A S
Published: December 2008

An enterolith (bezoar) usually originates in an intestinal diverticulum or in a segment of bowel loculated by stricture formation. Stasis promotes its formation. This communication describes a case in which a large enterolith caused obstruction and multiple perforations of the terminal ileum in the absence of any predisposing gastrointestinal pathology. The management of this rare occurrence is discussed and the literature reviewed.
Immobilization-related hypercalcaemia—a possible novel mechanism and response to pamidronate
Authors: Gallacher S J , Ralston S H , Dryburgh F J , Logue F C , Allam B F , Boyce B F , Boyle I T
Published: December 2008

Immobilization-related hypercalcaemia is an uncommon but important condition being associated not infrequently with both urolithiasis and osteoporosis. In this study 5 patients who had been immobilized for a mean of 3 months and had a mean adjusted serum calcium of 3.15 mmol/l were treated with doses of intravenous pamidronate ranging between 10 mg and 45 mg. All patients became normocalcaemic by day 3. Patients 1–3 mobilized shortly after treatment and remained normocalcaemic. In those patients who continued to be immobile hypercalcaemia recurred after an interval of several weeks. Retreatment with pamidronate again resulted in normocalcaemia. No side effects were noted with treatment.

All of the patients studied had increased rates of bone resorption as shown by elevated urinary hydroxyproline/creatinine ratios (median:range) of 0.101:0.045–0.180 (normal < 0.033) and elevated calcium/creatinine ratios of 2.50:0.69–3.63 (normal < 0.50).

None of the patients in this study had any of the usual risk factors for developing immobilization-related hypercalcaemia though all 5 patients had problems with significant sepsis which we postulate may have lead to cytokine release which in turn contributed to the development of hypercalcaemia.

We conclude that pamidronate (at doses as low as 10 mg) is safe and effective in immobilization-related hypercalcaemia and suggest that sepsis should be added to the list of risk factors for development of this syndrome.
Superadded aspergillosis on carcinoid bronchial adenoma leading to delayed diagnosis
Authors: Kumar L , Singh M , Mitra S K , Bannerjee C K
Published: December 2008

A review of aspergillosis in neoplastic disease revealed that most cases occur in association with malignant disorders. Amongst solid tumours it is mostly adenocarcinomas which are invaded by the fungus due to necrotic cavity formation. We here record the first reported association of aspergillosis with a benign carcinoid bronchial adenoma which was hidden by the fungal growth with a delay in diagnosis.
Nemaline myopathy: a report of two siblings as evidence of autosomal recessive inheritance of the infantile type
Authors: Cartwright J D , Castle D J , Duffield M G , Reef I
Published: December 2008

We report two opposite-sex siblings with the severe infantile form of nemaline myopathy; diagnoses were made on muscle biopsy. Neither parent showed clinical or electromyographic evidence of myopathy, and both had negative muscle biopsies. Autosomal recessive inheritance seems likely.
Spontaneous rupture of a splenotic nodule
Authors: Lanigan D J
Published: December 2008

A case is presented of spontaneous rupture of splenic tissue occurring 14 years after a splenectomy was carried out for trauma. Spontaneous rupture of a splenotic nodule has not previously been described and it may be added to the list of causes of spontaneous haemoperitoneum. The incidence and function of residual splenic tissue are briefly discussed and other causes of splenic rupture are outlined.
Poor response of breast cancer to tamoxifen
Authors: McDonald P J , Carpenter R , Royle G T , Taylor I
Published: December 2008

Fifty eight (58) patients with early breast cancer (mean age 78.3 years) and 37 patients with advanced breast cancer (mean age 65.9 years) were treated with tamoxifen orally 20 mg daily or twice daily. The mean follow-up time was 19.1 months in the early group and 18.4 months in the late group. The drug was extremely well tolerated. All patients had cytological or histological evidence of breast cancer. A complete or partial response was found in only 36% of the patients with early breast cancer and only 13% in the advanced group. We conclude that tamoxifen was disappointing as a primary therapy in our patients. Although because of its lack of toxicity it can be seen as initial therapy for patients with breast cancer, it may have to be supplanted rapidly by other forms of therapy in the substantial proportion of patients in whom a response will not occur.
Ethnic minorities, health provision and the 1976 Race Relations Act
Authors: Bedi R , MacEwen M
Published: December 2008

The present anti-racial discrimination legislation in the United Kingdom is embodied in the 1976 Race Relations Act. In essence this Act attempts to avoid any form of direct or indirect discrimination on the basis of racial or ethnic origin. However, health professionals are acutely aware that there are important racial differences in disease, some of which are, in fact, not racial but merely associated with social deprivation, poor housing and, of course, the incapacity to speak English.

These new findings present the medical profession, in the climate of scarce resources, with the challenge of meeting these needs without discriminating in favour of, or against, individuals on the basis of their race. This is because there are few provision in the 1976 Act to allow for such discrimination, even when it is for an ethnic group's advantage. The dilemmas this raises for health professionals who are involved in planning services for ethnic minorities are discussed.
Capgras' syndrome with organic disorders
Authors: Collins M N , Hawthorne M E , Gribbin N , Jacobson R
Published: December 2008

Capgras' syndrome, one form of the delusional misidentification syndromes, is described. Three patients with the syndrome are reported. The first had a right cerebral infarction, the second had nephrotic syndrome secondary to severe pre-eclampsia in the puerperium, and the third had uncontrolled diabetes mellitus with dementia. Evidence is reviewed regarding an organic aetiology for Capgras' syndrome. We conclude that, when the syndrome is present, a thorough search for organic disorder should be made.
Acute myocardial infarction in sickle cell anaemia associated with severe hypoxia
Authors: Saad S T O , Arruda V R , Junqueira O O M D , Schelini F A , Coelho O B
Published: December 2008

A 17 year old boy with sickle cell anaemia presented with acute myocardial infarction associated with severe hypoxia and reticulocytopenia. Ischaemic heart disease is rare in sickle cell anemia and in this case it is possible that the acute episode of hypoxia led to myocardial infarction.
Elevated human chorionic gonadotrophin levels in a patient with pancreatic carcinoma presenting with a testicular metastasis
Authors: Taylor H , Heaton N , Farrands P , Kirkham N , Fletcher M
Published: December 2008

Elevated levels of human chorionic gonadotrophin are associated with primary testicular tumours and usually indicate the presence of trophoblastic elements. Human chorionic gonadotrophin can also be secreted by extragonadal tumours which may metastasize to the testes. A patient is described presenting with a testicular tumour secreting human chorionic gonadotrophin which later proved to be a metastasis from a pancreatic adenocarcinoma. Up to 70% of malignant pancreatic tumours can secrete human chorionic gonadotrophin.
Endoscopic drainage of a recurrent pancreatic pseudocyst
Authors: Grewal H P , London N J M , Carr-Locke D , Wood K F
Published: December 2008

Pancreatic pseudocyst is a significant complication of both acute and chronic pancreatitis. Several methods of cyst drainage have been described. Endoscopic cystogastrostomy is a relatively new technique which is illustrated by the following case report, the first in the UK literature.
Solitary gastric hamartomatous polyp and upper gastrointestinal haemorrhage: an exceptional presentation of an unusual diagnosis
Authors: Erdozain J C , Sánchez-Ruano J J , San Román A L , Boixeda D , Moreira V F , Plaza A G
Published: December 2008

A case of solitary gastric hamartomatous polyp, presenting as upper gastrointestinal haemorrhage, is reported. Both the entity itself, and the clinical presentation, are exceptional. The significance of the solitary gastric hamartomatous polyp and implications of its diagnosis are discussed.
Acrocyanosis in anorexia nervosa
Authors: Bhanji S , Mattingly D
Published: December 2008

Acrocyanosis, an uncommon disorder of the peripheral circulation, may occur in patients with anorexia nervosa. It is not known why this should be, nor whether acrocyanosis correlates with any other features of the disorder. The findings in an unselected series of 155 anorectics are reported. Acrocyanosis occurred in 32 and was more prevalent among the more severely ill. It was associated also with pallor of the face and trunk, slower pulse rates and higher fasting plasma glucose levels. Acrocyanosis could represent a more extreme form of a heat conserving mechanism not uncommon in anorectics. The possible relationship between peripheral vascular changes and plasma glucose levels requires further study.
A new breast screening programme–an audit of the first year
Authors: Kirby R M , Williams M , Hopper G , Skinner M D , French C , Suarez V , Summerly M E , Gray J G
Published: December 2008

The experience of a new breast screening unit is reported. In the first 12 months there was a 72.1% response rate with 9890 women being screened. After the initial screen 598 (5.8%) were referred to the Assessment clinic. Following repeated mammography and clinical examination 166 patients were referred for a surgical opinion; 105 (1.06% of the total screened) were considered to be possibly malignant; 61 further patients with clinical and mammographically benign disease were kept under review by a single surgeon; 101 patients had excision biopsies; 28 of 32 palpable breast lumps and 36 of 69 non-palpable lesions proved to be malignant.
Myoclonus: a manifestation of neurocysticercosis
Authors: Puri V , Chowdhury V , Gulati P
Published: December 2008

A case of neurocysticercosis in an 11 year old female manifesting only as myoclonic seizures is reported. The diagnosis was based upon ELISA test, computed tomography, and biopsy of a subcutaneous nodule. The patient responded to anticysticerci drug treatment.

Neurocysticercosis has not to our knowledge been previously reported to have presented with myoclonus.
A typhus-like illness caused by acute HIV seroconversion
Authors: Brook M G , Barnes A , Cook G C , Mabey D C W
Published: December 2008

A patient is described in whom an acute human immunodeficiency virus seroconversion illness occurred following a trip to southern Africa. The presentation was strikingly similar to that of African tick typhus and could only be distinguished by serological testing.
Haemoperitoneum caused by Meckel's diverticulum
Authors: Sitaram V , Fox J N
Published: December 2008

A case of Meckel's diverticulum presenting acutely with spontaneous haemoperitoneum is presented. This complication has not, to our knowledge, been previously reported.
Plasma exchange in the treatment of Guillain-Barré syndrome: experience in a sub-regional referral centre
Authors: Anderson N A B , Kyriakides T , Ferguson I T , Wallington T B
Published: December 2008

Plasma exchange became popular in the treatment of Guillain-Barré syndrome with the publication in 1985 of results by the Guillain-Barré Study Group. Since then we have treated 24 patients referred for plasma exchange. We have audited their outcome and compared this with the results of patients in the treatment arm of the USA Study. Our patients were of comparable age and clinical severity and had similar duration of illness before starting plasma exchange. Nine of our patients required ventilation for a median of 24 days. The median time to improve one clinical grade was 19 days which compared well with the Study Group results. We have shown that plasma exchange may be safely performed in a district general hospital in a setting appropriate to the patient's clinical condition. We concur with the central conclusion of the Study, that if treatment is started early in the disease, the patient's outcome is improved.
Severe diabetic retinopathy at presentation in a young man
Authors: Morris G C , James R A , Powell R G , Jones M K
Published: December 2008

A 22 year old man presented with a severe ischaemic diabetic retinopathy and, in spite of photocoagulation therapy, was blind in one eye 16 months after diagnosis. Four similar cases of aggressive diabetic retinopathy are reviewed. There is increasing evidence that a small group of young men with insulin dependent diabetes (IDD) may develop severe diabetic retinopathy at, or soon after, diagnosis.
Primary sclerosing cholangitis associated with systemic sclerosis
Authors: Fraile G , Rodríguez-García J L , Moreno A
Published: December 2008

Primary sclerosing cholangitis is a chronic inflammatory fibrotic disorder strongly associated with inflammatory bowel disease. Although an association between some inflammatory fibrotic conditions, such as Riedel's thyroiditis and retroperitoneal fibrosis and primary sclerosing cholangitis has been described, to our knowledge there are no reports of primary sclerosing cholangitis in patients with systemic sclerosis.

A patient with this combination of conditions is presented and the possible significance of the association discussed.
Occult carcinoma in an adult choledochal cyst
Authors: Dowsett J F , Rode J , Chandiramani V A , Russell R C G
Published: December 2008

The complications of choledochal cyst are avoidable if diagnosed early, and adequate resection undertaken. This case report describes the long history of right subcostal pain in a young man of 26 who had a squamous carcinoma in a choledochal cyst diagnosed after serial section of the excised cyst. Subsequent resection of the head of the pancreas showed histological residual tumour from which he died 4 months later. This case illustrates the need for complete early excision of a choledochal cyst to prevent this complication.
Prognostic significance of serum iron levels in cases of Japanese encephalitis
Authors: Bharadwaj M , Prakash V , Mathur A , Chaturvedi U C
Published: December 2008

Forty-one children with acute laboratory confirmed Japanese encephalitis were studied. Serum iron concentrations were consistently low following Japanese encephalitis virus infection, with the levels being of prognostic significance.
Biochemical effects of urapidil on red cell membrane ion transport systems in a population of elderly essential hypertensives
Authors: Antonicelli R , Balducci E , Lipponi G , Lucantoni C , Gaetti R , Paciaroni E
Published: December 2008

The aim of our work was to verify the effect of urapidil on membrane ion transport systems. This was a randomized, double-blind, cross-over study which evaluated the clinical and biochemical effects of urapidil (30 mg twice daily in comparison with placebo) in a group of 10 elderly hypertensive patients (3 male, 7 female ranging from 68 to 90 years, mean age 79.2 ± 7.6 years). For the evaluation in fresh erythrocytes of principal ion transport systems (cotransport Na+/K+, countertransport Na+/Li+, Na+/K+ ATPase pump. intracellular Na+ and K+) we used the nystatin technique. We found that urapidil activated the red cell membrane ions cotransport system (basal values: 83.7 ± 50.3 mumol Na+ RBC 1−1.h−1, after 1 month of urapidil therapy: 181.5 ± 89.3 mumol Na+ RBC 1−1.h−1) (P < 0.01), without significant changes in the other biochemical parameters evaluated.

Our data suggest that one of the mechanisms of the urapidil antihypertensive effect could involve an increase in the membrane sodium cotransport system.
Bilateral carotid aneurysms unmasked by severe hypopituitarism
Authors: Michils A , Balériaux D , Mockel J
Published: December 2008

We describe a patient who initially presented with severe hyponatraemia and grand mal seizures, without any focal neurological symptoms. The final diagnosis was that of giant bilateral carotid aneurysms extending into the sella turcica with anterior hypopituitarism. To the best of our knowledge, this is the first case report of symmetrical carotid aneurysms manifested exclusively by an acute endocrine emergency with none of the concomitant usual focal signs such as headache, failing vision, oculomotor palsy or subarachnoid hemorrhage.
Dramatic oligoclonal paraproteinaemia following a pneumococcal septicaemia
Authors: Probert C S J , Roland J M , Simpson K R , Fairham S A
Published: December 2008

We describe a case of paraproteinaemia in which there were high concentrations of four monoclonal bands shown on qualitative, and confirmed by quantitative, techniques. The disorder followed a pneumococcal infection and resolved spontaneously with the complete disappearance of all four bands.
Prevalence of anticardiolipin antibodies in the elderly British population
Authors: Chakravarty K K , Gray R E , Webley M , Byron M A , Wozniak J
Published: December 2008

In a cross-sectional study of 100 healthy elderly individuals, anticardiolipin antibodies (aCL) were measured using an ELISA technique. aCL were not detected in the majority of subjects (63%), and in the remaining 37% titres were within the laboratory reference range (mean +5 standard deviations) previously determined for adults of all ages. In contrast, significant titres of IgM rheumatoid factor were found in 10%, antimitochondrial antibody in 13%, antinuclear factor in 5%, anti-smooth muscle antibody in 18%, antiparietal cell antibody in 10%, and antireticulin antibody in 1%. Antibodies to single or double-stranded DNA were not detected in any subject.

We conclude that, although other auto-antibodies may be present in the healthy aging population in Britain, abnormally elevated levels of aCL antibody do not occur, and when present may be an indicator of autoimmune-mediated pathology.
Surgical palliation for pancreatic carcinoma
Authors: Zamboni W A , Fisher K S , Ross D S
Published: December 2008

A review of 122 patients treated for pancreatic adenocarcinoma from January 1978 through December 1984 was accomplished to determine patient survival and the effect of surgical palliation. One hundred patients underwent laparotomy, including biopsy only (n = 42), biliary bypass (n = 30), gastric bypass (n = 1), biliary and gastric bypass (n = 14), and curative resection (n = 13). Total patient median survival was 3.6 months and no patient lived 5 years. No significant difference in survival was found between the biliary bypass and combined biliary-gastric bypass groups. Only 1 of 30 patients (3.3%) undergoing biliary bypass alone without evidence of pre-operative gastric outlet obstruction developed late gastric outlet obstruction requiring gastrojejunostomy. Operative time and postoperative morbidity were greater in the biliary-gastric bypass group. These results do not support routine prophylactic use of gastrojejunostomy at the time of biliary bypass for patients with unresectable carcinoma of the pancreas.
Guillain-Barré syndrome associated with rubella
Authors: Atkins M C , Esmonde T F G
Published: December 2008

A 34 year old male patient with Guillain-Barré syndrome following rubella is described. Diagnosis of the infection was made by the detection of specific IgM and IgG antibody. This is a rare association and has not been previously reported in an adult without a characteristic rash.
Intravenous gammaglobulin therapy in the thrombocytopenia of haemorrhagic varicella
Authors: Large D M , Basu A , O'Brien H
Published: December 2008

We report the case of a teenage boy with thrombocytopenia complicating varicella infection, which responded promptly to treatment with intravenous immunoglobulin therapy. Such treatment is well recognized in the management of immune thrombocytopenia, particularly where steroids are contra-indicated, but we have not found any previous case reports of the use of immunoglobulin in this condition.