bluuebunny/crossref_metadata_2025 huggingface dataset:
Special investigations of COCM: endomyocardial biopsies (morphological analysis)
Authors: Olsen E G J
Published: December 2008

Endomyocardial tissue obtained from 237 patients clinically suspected of suffering from congestive cardiomyopathy, has been analysed histologically, histochemically and ultrastructurally. In 51% of patients, the suspected diagnosis was morphologically confirmed and in 24·5%, no pathological evidence of a dilated heart or other pathology was found. The results in these two groups were considered helpful.

It is concluded that, even though the morphology of congestive cardiomyopathy in non-specific and the number of other pathology found is small, the continuation of investigation by bioptome is justified. Parameters such as prognosis and length of history can also be assessed. Furthermore, morphological analysis is essential to interpret accurately biochemical and other types of investigations that are being carried out on biopsy material.
Dermatomyositis: observations on the use of immunosuppressive therapy and review of literature. Cairo—Glasgow study group
Authors: El-Ghobarey A , Balint G , de Ceulaer K , Dick W C , Buchanan W W , Hadidi T , Hassan T A
Published: December 2008

Seven young adults, six of whom were male, all suffering from dermatomyositis unassociated with malignancy are described. These patients were not adequately controlled with high doses of corticosteroids but all responded when immunosuppressive therapy was also given.
Sarcoidosis with renal involvement
Authors: MacSearraigh E T , Doyle C T , Twomey M , O'Sullivan D J
Published: December 2008

Nine of ninety patients with sarcoidosis were found to have significant renal impairment. Epithelioid granulomata were present in five of eight patients who had renal biopsies and glomerular lesions were present in six. There was close correlation between hypercalcaemia, hyperuricaemia, nephrocalcinosis and creatinine clearance. In one patient, renal sarcoidosis complicated membrano-proliferative glomerulonephritis and one patient died in end-stage renal disease.
Three additional malignancies occurring within one year in a patient with chronic lymphatic leukaemia
Authors: Boots M A , Pegrum G D
Published: December 2008

A patient with crhonic lymphatic leukaemia (CLL) is presented who was first seen with a basal cell carcinoma and subsequently developed two further malignant conditions within a year, without receiving any treatment for his leukaemia. It is suggested that this leukaemia was a predisposing factor in the development of his carcinomas.
Induction of spermatogenesis in hypogonadotrophic hypogonadism
Authors: Spitz I M , Schumert Z , Steiner J , Rosen E , Segal S , Slonim A , Rabinowitz D
Published: December 2008

A young male who presented with isolated bihormonal gonadotrophin deficiency is described, Basal levels of LH and FSH were low and there was no response to clomiphene citrate or LHRH. The remaining anterior pituitary function was intact. The administration of a combination of human menopausal gonadotrophin and human chorionic gonadotrophin caused testicular maturation with spermatogenesis and full androgenization. The patient was able to father a child.
Early outbreaks of ‘epidemic neuromyasthenia’
Authors: Parish J G
Published: December 2008

The literature of the outbreaks of ‘epidemic neuromyasthenia’ (ENM) from 1934 to 1955 has been selected to show that the disease affects other people besides young adult females in hospitals and nursing homes. There have been district epidemics, in which the male: female ratio was almost even and several male outbreaks affecting soldiers in barracks. Some outbreaks appear to have been triggered off by an epidemic of poliomyelitis, and the epidemiology of outbreaks in Iceland in 1948 and 1955 suggests that the normal cytopathological effects of poliomyelitis infection have been suppressed by the new disease. In the Durban epidemic (1955) a toxic metabolite was discovered in the urine of many patients and a markedly increased urinary excretion of creatine was noted in two New York State outbreaks. The results of the transmission of an agent from patients with ENM to monkeys suggest that the neurological disorder might be in the form of mild disseminated lesions scattered throughout the nervous system from the brain to peripheral nerves and associated with perivascular round cell infiltration without significant cellular damage. ENM infection was widespread in the North of England in 1955 and associated with lymphocyte abnormalities, which have persisted in some cases for several years. This suggests a continuous organic process.
‘Epidemic neuromyasthenia’ 1955–1978
Authors: Ramsay A M
Published: December 2008

A record of fifty-three patients admitted to the Infectious Diseases Department of the Royal Free Hospital between April 1955 and September 1957 suffering from ‘epidemic neuromyasthenia’ establishes the fact that the condition was endemic in the general population before, during and after the outbreak among the staff of the hospital. A further outbreak occurred in North Finchley between 1964 and 1967 and sporadic new cases are still being encountered. The majority of these patients show evidence of involvement of the central and sympathetic nervous systems and the reticulo-endothelial system. Abnormal muscular fatigability is the dominant clinical feature and it is suggested that mitochondrial damage may provide an explanation for this phenomenon. Enzyme tests carried out in seven cases show pathologically high levels of lactic dehydrogenase, and glutamic oxalo-acetic transaminase. A follow-up study suggests that there is one group of patients that recovers completely or nearly completely, a second that recovers but is subject to relapses and a third that shows little or no recovery, these patients remaining incapacitated.
Electro-encephalographic investigations in myalgic encephalomyelitis
Authors: Pampiglione G , Harris R , Kennedy J
Published: December 2008

The main EEG features are described of thirty-six young adults who were examined at the Royal Free Hospital between 1960 and 1964 and twelve children seen at the Hospital for Sick Children, Great Ormond Street, London, between 1957 and 1977. It is important in the future, if a plan is considered for the study of a fresh epidemic, to include systematic EEG studies covering a period of 2 to 3 years. The EEG alterations found in this limited survey, though modest, would suggest that cerebral function was disturbed with somewhat variable distribution by an insidious illness which has not yet been identified.
Post-infectious encephalomyelitis: some aetiological mechanisms
Authors: Behan P O
Published: December 2008

The possibility that acute disseminated encephalomyelitis (ADEM) and epidemic myalgic encephalomyelitis (‘epidemic neuromyasthenia’) may share a common pathogenesis is examined and many factors common to the two diseases are described. It is suggested that further study of ADEM may help our understanding of epidemic myalgic encephalomyelitis.
The neurological manifestations of malabsorption
Authors: Cooke W T
Published: December 2008

The clinical and pathological findings in patients with neurological disorders in association with disordered function of the small intestine, in particular coeliac disease, are outlined. The possible significance of the abnormalities of pyridoxine, tyrosine and tryptophan metabolism are considered in relation to biopterin derivatives and their relevance to neurological dysfunction.
Scurvy and vitamin C deficiency in Crohn's disease
Authors: Linaker B D
Published: December 2008

A case of scurvy presenting in a patient with Crohn's disease is reported. A normal response to replacement therapy is seen. Vitamin C (ascorbic acid) deficiency was found in 7 out of 10 patients with clinically quiescent Crohn's disease, 4 of whom had an adequate oral intake of vitamin C. There was no significant difference in oral intake between patients with Crohn's disease and matched controls but there was a significant difference (P<0·001) in leucocyte ascorbic acid levels. It is recommended that patients with Crohn's disease be screened for vitamin C deficiency and receive prophylactic vitamin C supplements daily.
Interferon induction by adenoviruses
Authors: Béládi I , Pusztai R , Bakay M , Mucsi I , Taródi B
Published: December 2008

All human, simian, bovine and avian adenovirus types tested so far and the canine hepatitis virus induce interferon production in chick cells. This finding indicated this property to be characteristic for viruses belonging to the adenovirus group. Trypsin treatment, which had no effect upon the infectivity, diminished or eliminated the interferon-inducing abilities of crude adenoviruses, and thus the need for a trypsin-sensitive protein in interferon induction was suggested. T antigen and interferon were formed simultaneously in chick embryo fibroblast cells infected with human adenovirus type 12, and therefore the adenovirus-specific T antigen was resistant to the action of endogenous interferon synthetized by the same cells. In chicks inoculated with human types, the appearance of interferon was biphasic: an ‘early’ and a ‘late’ interferon could be demonstrated with maximum titre 4 and 10 hr, respectively, after virus infection. In chicks infected with adenoviruses, first interferon production and then a decreased primary immune response to sheep red blood cells was observed. It was assumed that in adenovirus-infected chicks the interferon produced by viral stimulus resulted in a transient immunosuppression.
Pancreatitis in childhood
Authors: Sibert J R
Published: December 2008

Follow-up of 25 cases of pancreatitis in childhood ascertained from the Hospital Activity Analysis in Newcastle and Wales showed that the majority of the children thrived after their illness. Only one child died. Only 2 children developed diabetes mellitus and 3 had significant malabsorption.

There were 13 idiopathic cases (9 acute, 4 chronic relapsing), 3 of which were obese girls of pubertal age. It is speculated that obesity, puberty and female sex together may predispose to acute pancreatitis.
Interatrial abscess
Authors: Holt S , Martinez A A G , Coulshed N
Published: December 2008

A large abscess of the interatrial septum developed during the course of acute bacterial endocarditis affecting the aortic valve. Septic involvement of the cardiac conducting system produced atrioventricular dissociation, and subsequent abscess rupture resulted in an aorto-right atrial communication. The clinical presentation of this rare complication of acute bacterial endocarditis is correlated with the post-mortem findings.
Colonic tuberculosis
Authors: Venables G S , Rana P S
Published: December 2008

A case of tuberculosis of the colon is described. Attention is drawn to the similarity between this and other inflammatory diseases of the bowel. Colonic tuberculosis is now a rarity even where mycobacterial infection is endemic, and may mimic other inflammatory diseases of the bowel with important consequences for treatment and prognosis. Such a case is now described.
Nutrition and lactation
Authors: Whitehead R G
Published: December 2008

Recommended dietary allowances for women during pregnancy are discussed in the light of actual intakes both in the developing and industrialized countries. The difference between total energy intakes in the industrialized countries (around 2900 kcal) and in the developing countries (around 1600 kcal) is emphasized. Data are provided from The Gambia which demonstrate the effect of seasonal changes in maternal dietary intake on the quantity of breast milk produced and on its quality. The relationship between breast-milk supply and infant growth is also demonstrated.
Respiratory disease in pregnancy
Authors: de Swiet M
Published: December 2008

Respiratory disorders seem to be better tolerated during pregnancy than disorders of the cardiovascular system. Pregnancy seems to have a variable effect on bronchial asthma although respiratory function in general shows little change. Similarly patients with bronchiectasis do not tend to show functional deterioration. Fetal growth, however, may be adversely affected in these conditions if arterial hypoxaemia is present. The problems of drug treatment of respiratory disorders in pregnancy, particularly asthma and tuberculosis, are discussed.
Renal physiology in pregnancy
Authors: Dunlop W
Published: December 2008

The changes which occur in renal excretory function during pregnancy are discussed. The relationship between glomerular filtration rate and effective renal plasma flow is examined in the light of new serial data obtained under conditions of saline diuresis. Changes in the renal handling of nutrients and in the excretion of waste products during pregnancy are reviewed.
Trigeminal neuropathy as the presenting symptom of systemic sclerosis
Authors: Burke M J , Carty J E
Published: December 2008

Three cases of systemic sclerosis in which trigeminal neuropathy was the presenting symptom are described. All 3 patients had progressive diseases and 2 died from its complications.

In each case extensive neurological investigation was undertaken before the disease was recognized and it is suggested that earlier recognition of the systemic sclerosis might obviate the need for this. Trigeminal neuropathy in systemic sclerosis was associated with a poor prognosis in 2 of the patients.
Birmingham Medical Research Expeditionary Society 1977 Expedition: Psychological aspects of acute mountain sickness
Authors: Olive J E , Waterhouse N
Published: December 2008

In order to assess the importance of personality and expectations in the development of Acute Mountain Sickness (AMS), 3 standard personality questionnaires and a Mountain Sickness Anticipation Questionnaire were completed by all of the 17 BMRES expedition members before their departure for the Himalayas. AMS could not be predicted with these tests and its occurrence, when assessed either by clinical interview or by peer review, bore no significant relationship to personality. For comparison daily self-assessment of the signs and symptoms of AMS were also conducted throughout the expedition, using graduated and graphic rating scales. The results were found to be unreliable and dependent upon personality factors. These findings have implications for those assessing others at high altitude.
Birmingham Medical Research Expeditionary Society 1977 Expedition: effect of a Himalayan trek on whole body composition, nitrogen and potassium
Authors: Harvey T C , James H M , Chettle D R
Published: December 2008

The body composition of the 17 members of the BMRES was studied using body weight and fat fold calipers, with measurements of whole body potassium and nitrogen. The full assessment was made just before departure from Birmingham and immediately on return. Daily observations of body weight and fat folds were made during the trek to high altitude.

During the ascent all subjects lost body fat but there was little change in lean body mass. After return it was found that there had been further loss of body fat and some loss of lean tissue also. One subject who took methandienone retained potassium but had no increase in body nitrogen. There was no correlation between changes in body composition and acute mountain sickness.
Birmingham Medical Research Expeditionary Society 1977 Expedition: serum and urine proteins during a high altitude trek
Authors: Bradwell A R
Published: December 2008

Serum and urine proteins were measured daily in 17 subjects undertaking a typical high altitude Himalayan trek. Marked changes occurred in a variety of serum proteins as a result of plasma volume alterations and 'stress'. There was only a sporadic increase in proteinuria. None of the changes was related to the development of acute mountain sickness.
Birmingham Medical Research Expeditionary Society 1977 Expedition: changes in renal function observed during a trek to high altitude
Authors: Delamare J P , Jones G T
Published: December 2008

Changes in renal function were observed in 17 subjects during the course of a trek to high altitude. Comparison was made between these changes and the clinical assessment of acute mountain sickness (AMS).

Periods of natriuresis occurred during ascent and descent, that during ascent being related to a fall in plasma aldosterone. Alterations in serum and urinary potassium suggested that potassium retention occurred during the ascent to altitude.

No significant correlation occurred between changes in renal function and the severity of AMS before the illness being clinically apparent. When this was so, the severity of AMS correlated with a decreasing urine output, increasing positive fluid balance and a decreasing excretion of sodium and potassium; these changes were produced in part by a decrease in glomerular filtration rate.
Imported fungal infections
Authors: Mackenzie D W R
Published: December 2008

Data on mycoses known to be imported into the United Kingdom are sparse. Estimates on the prevalence of fungal infections have to be based on indirect and incomplete figures, obtained from isolation figures and reports of individual cases to co-ordinating centres such as the Mycological Reference Laboratory and the Communicable Disease Surveillance Centre of the Public Health Laboratory Service.

Imported species of dermatophytes account for less than 1% of the total number of isolations made annually at mycological laboratories throughout the U.K. A suggested prevalence of dermatophytosis in this country is c. 250 000 cases per annum. Trichophyton rubrum may now be the most common species of dermatophyte.

Other estimates of the frequencies with which infections are recorded each year include mycetoma (7–10), histoplasmosis (2–5), aspergilloma (50–80), invasive aspergillosis (10–30), Candida vaginitis (≽ 1 000 000), invasive candidiasis (10–80), Candida endocarditis (1–2) and cryptococcosis (6–10).
Mycoses imported from the West Indies. A report of three cases
Authors: Hay R J
Published: December 2008

There have been isolated case reports of deep fungal infections from the Caribbean area but little is known about the distribution of mycoses there. Three cases, one of mycetoma, one of chromomycosis, one of histoplasmosis, are described. Their management and the advantages and disadvantages of treatment outside the area of origin are discussed.
Evaluation of vaginal antifungal formulations in vivo
Authors: McRipley R J , Erhard P J , Schwind R A , Whitney R R
Published: December 2008

Relatively simple and rapid procedures have been developed for evaluating the local efficacy of vaginal antifungal agents in vivo in a vaginal candidiasis model in ovariectomized rats. The results of this investigation indicate that the model and methods described are quite suitable for screening potential antifungal substances and for assessing the chemotherapeutic effectiveness of new antifungal agents and formulations before carrying out clinical studies.
The polyene macrolide antibiotics
Authors: Kerridge D
Published: December 2008

The mode of action of the polyene antibiotics is reviewed together with the effect of genetic and environmental factors on sensitive organisms. The future prospects of polyenes in the treatment of systemic mycoses are considered.
The effect of metoprolol on plasma lipids
Authors: Beinart I W , Cramp D G , Pearson R M , Havard C W H
Published: December 2008

Fifteen hypertensive patients entered a single-blind study to examine the effects of metoprolol (100 mg twice daily) on fasting plasma lipids. In 12 patients who completed the study, non-esterified fatty acid concentrations fell, but cholesterol and triglyceride levels were unchanged after 12 weeks' treatment. These results conflict with earlier reports of the effect of metoprolol on plasma triglyceride concentrations.
Heat oedema: a clinical study
Authors: Sitprija V
Published: December 2008

Transient generalized oedema was observed in a patient upon exposure to a hot climate. Oedema disappeared in 5 days. Clinical study during oedema revealed decreased urine volume, high urine osmolality, high urine sodium concentration, increased blood volume, hyponatraemia and hypo-osmolality. The total solute excretion was unchanged. The endogenous creatinine and para-aminohippurate clearances were normal. The findings were suggestive of increased antidiuretic hormone activity, and heat might be responsible.
Epileptiform seizures with maprotiline hydrochloride
Authors: Marks P , Anderson J , Vincent R , Hutchinson J T , Rees H M
Published: December 2008

Two cases are described who developed epileptic seizures whilst taking maprotiline hydrochloride in therapeutic dosage. In both cases the electroencephalogram was normal and the fits stopped on withdrawal of the drug.
Transplacental passage of anti-s̄ antibody without haemolysis
Authors: Goldstone A H , McVerry B A , Cooper M
Published: December 2008

The production of anti-s̄ antibodies during pregnancy is a rare event and usually causes haemolysis of fetal red cells. A case is presented where an IgG anti-s̄ antibody crossed the placenta, but did not produce any evidence of haemolysis.
Iron overload despite partial gastrectomy
Authors: Parfrey P S , Turnbull A L , Pollock D J , Barnett M
Published: December 2008

Iron overload was found in 3 patients who had undergone partial gastrectomy: a 61-year-old woman developed iron overload because she may have had idiopathic haemochromatosis and had also been given parenteral iron; in a 62-year-old man with thalassaemia minor, iron overload may have developed because of increased oral iron ingestion, low serum folate, increased, albeit ineffective, erythropoiesis and sideroblastic anaemia; a 74-year-old man with thalassaemia minor developed iron overload without exogenous therapy and died from a hepatoma. These cases illustrate that partial gastrectomy fails to protect patients from developing iron overload, particularly if given uncontrolled iron therapy.
Haematemesis in Ménétrier's disease
Authors: Dickinson R J , Axon A T R
Published: December 2008

Three patients with Ménétrier's disease presented with massive haematemesis. One patient died. Ménétrier's disease may be associated with gastrointestinal haemorrhage and although it is rare it should be borne in mind as a cause of upper gastrointestinal bleeding. In one patient an elevated serum gastrin was found and the possible significance of this is briefly discussed.
Tobramycin nephrotoxicity. A prospective clinical study
Authors: Coca Antonio , Martinez Alberto , Soriano Eladio , Blade Juan , Segura Fernando , Ribas-Mundo Manuel
Published: December 2008

The nephrotoxicity of tobramycin given at a dose of 4·5 mg/kg/day for a period of 12 days to a group of 90 patients with a mean age of 62·9 years was studied. Toxicity was determined on the basis of 3 main criteria (oliguria <400 ml/24 hr, serum creatinine 0·4 mg increase over a minimum basal level of 1·2 mg/100 ml, BUN 5 mg increase over a minimum of 25 mg/100 ml); and 3 minor criteria (proteinuria, microhaematuria and cylindruria). These parameters were determined before treatment at 7, 10, 14, 17, 21, and 30 days afterwards. The age and coexistence of factors such as hypertension, diabetes, anaemia, cardiac insufficiency, shock and dehydration were considered. Nephrotoxicity level ranges from 3·3 to 38·8% depending on the criterion used, and is related to hypertension (P<0·001), age (P<0·005) and association with ampicillin (P<0·005). Nephrotoxicity was reversible spontaneously in 96·7% of the cases and no differences have been observed between patients with moderate renal insufficiency and those with normal renal function on the initiation of treatment.
Symptomatic hypothalamic hypopituitarism following radiotherapy
Authors: Frier B M , Corrall R J M
Published: December 2008

A patient is described who developed symptomatic hypopituitarism within 18 months of radiotherapy for nasopharyngeal carcinoma. Detailed investigation indicated a lesion at hypothalamic level. The effect of radiation on hypothalamic-pituitary function is discussed.
Disseminated intravascular coagulation in association with congenital neuroblastoma
Authors: Thompson Eileen N , Bosley Alan
Published: December 2008

A 3-month-old infant with neuroblastoma complicated by progressive depletion of coagulation factors and a microangiopathic haemolytic anaemia is described. Specific anti-tumour therapy corrected the haemorrhagic defect on 2 occasions, but did not affect tumour bulk significantly, although a fall in urinary vanillyl-mandelic acid was seen. The rarity of this association and the possible underlying mechanisms are discussed.
Proliferating Brenner tumour
Authors: Baratz M , David M P , Gitstein S Z , Avni A
Published: December 2008

A new case of proliferating Brenner tumour is added to the 18 previously reported cases, and the literature relating to this particular kind of tumour is reviewed.
Iatrogenic ‘torsade de pointes’ ventricular tachycardia
Authors: Kounis Nicholas G
Published: December 2008

Three patients who developed a distinctive form of ventricular tachycardia with oscillating QRS axis, while they were receiving drugs known to prolong the repolarization time are described. In one of the patients suffering from psychiatric illness and receiving psychotropic drugs the arrhythmia was fatal. It is postulated that the tendency to this arrhythmia was augmented by repeated electric counter shocks and negative bathmotropic drugs. Functional factors may contribute to the pathogenesis of this arrhythmia which seems to constitute an entity.
Hypersecretion of anti-diuretic hormone due to tuberculous meningitis
Authors: Smith J , Godwin-Austen R
Published: December 2008

Three patients with tuberculous meningitis complicated by hypersecretion of anti-diuretic hormone are described. The recognition of this complication is important in the treatment and prognosis of tuberculous meningitis.
Eosinophilic pleural effusion with high anti-DNA activity as a manifestation of systemic lupus erythematosus
Authors: Wysenbeek A J , Pick A I , Sella A , Beigel Y , Yeshurun D
Published: December 2008

A patient, known to have systemic lupus erythematosus (SLE), presented with an eosinophilic pleural effusion. It is believed that SLE was the cause of her pleural effusion as increased levels of anti-DNA activity were found in the pleural fluid. Eosinophilic pleural effusion is a previosuly unreported observation in SLE patients (so far as the authors are aware), and the existence of increased anti-DNA activity in the pleural fluid may have value as an additional aid in the diagnosis of this disease.
‘Sick cell’ hyponatraemia and gastrointestinal electrolyte loss
Authors: Ghose R R
Published: December 2008

A patient with protracted vomiting was noted to have hyponatraemia and hypokalaemia on admission. Isotope dilution studies before treatment revealed profound body depletion of sodium, potassium and water. Treatment with potassium chloride tablets produced a simultaneous rise in serum sodium and potassium concentration without change in urine volume or osmolality, or body weight.

Potassium depletion appears to have contributed to the mechanism of hyponatraemia in this situation, and that replacement of potassium corrected hyponatraemia by effectively re-distributing solute and water across the cell membrane, so that sodium ions which had entered intr-cellular fluid during electrolyte depletion, subsequently returned to extracellular fluid after treatment.
Raynaud’s phenomenon induced by sulphasalazine
Authors: Reid J , Holt S , Housley E , Sneddon D J C
Published: December 2008

Sulphasalazine-induced Raynaud’s phenomenon is reported in a patient who showed no other features of a drug-induced lupus syndrome. The vascular disturbance disappeared when the drug was withdrawn on 3 occasions. A simple technique for assessing the circulatory abnormality in Raynaud’s phenomenon is described.
Increased slow wave sleep in a hypopituitary dwarf
Authors: Tormey W P , Darragh A S
Published: December 2008

The main features of the nocturnal EEG of a dwarf with evidence of hypothalamic disease were an increase in slow wave sleep (SWS), a reduction in stage 2 and no alteration in total rapid eye movement. Administration of growth hormone caused a further increase in SWS time.
Thorotrast administration followed by myelofibrosis
Authors: Arnold A G , Oelbaum M H
Published: December 2008

A case of myelofibrosis related to thorotrast administration is described. Current concepts of acute myelofibrosis are discussed, as are the varied complications of thorotrast.
An isolated right hypoglossal nerve palsy in association with infectious mononucleosis
Authors: Wright G D S , Lee K D
Published: December 2008

Following an upper respiratory tract infection, a teenage girl developed an isolated right XII nerve palsy; subsequently she was shown to have infectious mononucleosis. After 24 weeks her tongue had virtually recovered.
Salivary gland enlargement during oesophageal stricture dilatation
Authors: Martin D
Published: December 2008

A case of recurrent salivary gland enlargement occurring during fibreoptic oesophagoscopy and oesophageal stricture dilatation with Eder-Puestow dilators is described. The genesis of this condition is discussed and its transient and usually benign nature emphasized.
Cholestatic jaundice due to co-trimoxazole
Authors: Ogilvie A L , Toghill P J
Published: December 2008

A patient developed cholestatic jaundice following therapy with co-trimoxazole. Inadvertent re-challenge with the drug resulted in further clinical and biochemical deterioration, but complete recovery ensued on stopping this drug.
Triradiate deformity of the pelvis in Paget’s disease of bone
Authors: Chakravorty N K
Published: December 2008

Possibly owing to the rather unusual manner of its presentation, there is scant description of triradiate deformity of the pelvis in textbooks. Three cases are now described to illustrate this feature of Paget’s disease. Its approximate incidence is indicated.
Some cardiovascular problems with disopyramide
Authors: Warrington S J , Hamer J
Published: December 2008

Five patients with apparent adverse cardiovascular effects of disopyramide are reveiwed. Attention is drawn to the following problems.

(1) A vagolytic effect may produce a sinus tachycardia with wide QRS complexes due to aberrant conduction or intraventricular block superficially resembling a ventricular tachycardia, or may allow increased transmission of an atrial tachycardia or atrial flutter to the ventricles by improving atrio-ventricular conduction.

(2) Although the vagolytic effect is helpful in increasing sinus rate in patients with sinus node disease, disopyramide may lead to bradycardia and asytolic cardiac arrest, and should not be used without a demand pacemaker.

(3) Dangerous ventricular arrhythmias may be provoked in susceptible subjects, as with quinidine.

(4) Rapid intravenous injection may produce transient toxic effects before the drug is distributed. The rate of injection as a loading dose for prophylaxis should be slower (2 mg/kg in 15 min) than for the urgent conversion of a resistent tachycardia (2 mg/kg in 5 min).

Although disopyramide seems less toxic than quinidine, caution is advised, as over-enthusiastic application of disopyramide, particularly with rapid intravenous injection, might tend to bring a useful new agent into disrepute.
Pasteurella multocida meningitis
Authors: Smith F R
Published: December 2008

Pasteurella multocida appears to be a very rare cause of meningitis. The bacterium has morphological similarities with other causative organisms, particularly Haemophilus influenzae, and its apparent rarity may be due partly to misidentification. This case, only the fourth reported from the United Kingdom, could not be distinuished clinically from the meningitis, owing to other pyogenic bacteria.
Sarcoidosis associated with combined immunodeficiency
Authors: Crofts M J , Joyner M V , Sharp J C , Costello J , Vergani D
Published: December 2008

The association of multiple non-caseating granulomata and a positive Kviem test is normally considered to be indicative of a diagnosis of sarcoidosis. However, although depressed cell-mediated immunity is commonly described, it is extremely rare to find a humoral immune paresis.

A patient is reported who had multiple granulomata, depressed cellular and humoral immunity and a positive Kveim test.
Metastatic basal cell carcinoma: report of a case responding to chemotherapy
Authors: Woods R L , Stewart J F
Published: December 2008

Metastases of basal cell carcinoma are very uncommon. Only 10 reported cases have been treated with cytotoxic chemotherapy, and no good responses have been documented. The case is presented of a 54-year-old male who had several basal cell carcinomas (BCCs) removed surgically and who, 12 years after his first presentation, developed respiratory symptoms related to metastatic pulmonary BCCs. These failed to respond to initial chemotherapy with methotrexate, bleomycin, and vincristine, but regressed when treated with cyclophosphamide and cis-diamine dichloroplatinum.
Massive infarction of the uterus and appendages caused by torsion
Authors: Daw E , Saleh N
Published: December 2008

A case of torsion of the uterus and appendages is reported and discussed.
Pindolol-induced tremor
Authors: Hod H , Har-Zahav J , Kaplinsky N , Frankl O
Published: December 2008

Five patients were treated with pindolol for various indications. The patients called attention to the appearance of fine tremors in their extremities 6-72 hr after starting treatment with the drug. The tremors disappeared 24-72 hr after stopping the drug. Beta-adrenoceptor-blockers are known to suppress different types of tremor and the paradoxical appearance of tremors during pindolol treatment is attributed to its powerful partial agonist activity.

To the best of the authors’ knowledge this side effect has not been previously described in the literature.
Moduretic-induced metabolic acidosis and hyperkalaemia
Authors: Wan H H , Lye M D W
Published: December 2008

A patient who developed significant metabolic acidosis and severe hyperkalaemia while taking Moduretic (amiloride and hydrochlorothiazide) is reported. During the period of hyperkalaemia (maximum potassium 7-6 mmol/l) the patient’s whole body potassium content was normal. His acid-base balance and serum potassium returned to normal some 10 days after stopping the drug. The possible mechanism of acidosis and hyperkalaemia in this patient is discussed.
Jaundice associated with naproxen
Authors: Victorino R M M , Silveira J C B , Baptista A , de Moura M C
Published: December 2008

Hepatic injury in association with naproxen therapy is described and documented by liver biopsy in one patient. Histological findings were consistent with a drug-induced hepatitis, and cessation of therapy led to reversal of the clinical and biochemical changes. Circumstantial evidence is in favour of a hypersensitivity response to the drug rather than direct hepatotoxicity. Increased awareness of clinicians of this probably rare side effect of naproxen may help prompt identification of similar cases.
Systemic lupus erythematosus presenting as morbid jealousy
Authors: Ravindran A , Carney M W , Denman A M
Published: December 2008

A patient fulfilling the diagnostic criteria for systemic lupus erythematosus and presenting with morbid jealousy is described. There was evidence of cerebral lupus. Her physical and mental symptoms responded to a combination of chlorpromazine and steroids. The morbid mental process was probably caused by her physical condition while the content of her disordered thought and behaviour was determined by her introverted premorbid personality, religiosity, unhappy childhood experiences and frustrated desire for children.
A case of leiomyoma of the oesophagus complicated by superior vena cava obstruction and associated eosinophilia
Authors: Hickling P , Buksh K , Beck P
Published: December 2008

Superior vena cava obstruction occurring as a complication of leiomyoma of the oesophagus has not been reported before. Such a case is recorded which was associated with striking eosinophilia, a feature previously noted in cases of uterine leiomyomas.
Acute interstitial nephritis associated with gentamicin and lincomycin therapy
Authors: Bell G M , Thomson D
Published: December 2008

A case of acute oliguric renal failure following gentamicin and linocomycin therapy is described. Renal biopsy showed an acute interstitial nephritis. This was associated with high serum gentamicin levels and the later development of ototoxicity. Withdrawal of antibiotics and conservative measures was followed by rapid recovery of renal function. Attention is drawn to the association between gentamicin and lincomycin therapy and the development of an acute interstitial nephritis.
Primary adenocarcinoma of the appendix
Authors: Menon N K
Published: December 2008

Two cases of carcinoma of the appendix presenting as appendicular masses are discussed. Carcinoma of the appendix is rare and hence a pre-operative diagnosis is seldom made. Awareness of the condition would naturally arouse suspicion of its presence, especially in elderly patients who present with cute appendicitis or an appendix mass. It is known to have occurred in an appendix stump several years after the initial appendicectomy, and also in a 17-year-old patient. The need for histological examination of all appendicetomy specimens is stressed. The operation of choice is right hemicolectomy, either as a primary or as a secondary procedure. This is associated with better survival rates than when the condition is treated by appendicectomy alone.
Non-traumatic clostridial myositis: an unusual feature of brain death
Authors: Thys J P , Ectors P , Noel P
Published: December 2008

In a case of brain death, a Clostridium sordellii and Escherichia coli septicaemia--of probable gastrointestinal origin--developed and was associated with a diffuse clostridial myositis. Factors responsible for the initiation and development of this unusual clostridial infection are discussed.
The dietary prevention of coronary heart disease: dietary cholesterol and fat
Authors: Connor W E
Published: December 2008

Epidemiological, laboratory and experimental studies make it clear that dietary cholesterol (DC) and saturated fat, independently and together, are hypercholesterolaemic and atherogenic. Some work suggests that DC, usually given as egg yolk, is the more important, but often they are consumed together. There is a threshold, usually between 100 and 200 mg/day, below which small increments do not affect plasma cholesterol (PC) and another, usually between 500 and 600 mg/day, above which there is little additional change. However, there is considerable individual variation. Recent work suggests that regression of atherosclerosis can occur in the human as in the non-human primate. An alternative, phased, preventive diet has been designed which is nutritionally adequate, ecologically sound, and economical. It also has an historical basis.
The role of peritoneal biopsy in the diagnosis of ascites
Authors: Jenkins P F , Ward M J
Published: December 2008

Percutaneous biopsies of the peritoneum were obtained in 23 patients with ascites of unknown cause. The only case of tuberculous peritonitis was correctly diagnosed. Peritoneal biopsy provided a diagnosis of malignancy in 6 patients (one lymphoma, one mesothelioma, 4 cases of disseminated carcinoma) but failed to recognize a further 13 cases of disseminated carcinoma. Previous literature is reviewed and the diagnostic usefulness of this procedure is discussed.
Blood pressure and sodium balance in hypertensive patients in hospital
Authors: de Leeuw P W , Birkenhäger W H
Published: December 2008

Ninety-one subjects with uncomplicated essential hypertension were admitted to hospital. They received a diet with a fixed amount of sodium (55 mmol/day), without calorie restriction.

Blood pressure was measured at 2-hr intervals and averaged for each day. In patients who apparently adhered to a low salt diet before admission (group I), BP dropped 5 mmHg during the first 24 hr and then remained stable. In patients who previously ingested more salt (group II) a similar drop in pressure occurred during the first day, but pressure declined another 6 mmHg during the second day, to stabilize thereafter.

Both neurovegetative and sodium-dependent factors appear to contribute to the decrease in BP while the patient is in hospital.
Cholestatic jaundice: an immune response to prajmalium bitartrate
Authors: Rotmensch H H , Liron M , Yust I , Klejman A , Livni E , Moalem T , Gefel A
Published: December 2008

Cholestatic jaundice associated with chills, pruritus and blood eosinophilia developed in a patient who received prajmalium bitartrate therapy for ventricular arrhythmia following acute myocardial infarction. Discontinuation of the drug resulted in a spontaneous improvement in the clinical and biochemical findings. Challenge by prajmalium bitartrate caused rapid reappearance of the clinical and biochemical features.

In immunological studies, deposits of IgG and IgA were detected at the bile canaliculi by fluorescent staining, and the patient’s lymphocytes produced macrophage migration inhibition after in vitro incubation with prajmalium bitartrate. Thus, laboratory results support the assumption of an allergic mechanism.
Formic acid poisoning
Authors: Jefferys D B , Wiseman H M
Published: December 2008

Forty-five cases of formic acid poisoning are reviewed. The metabolic and pathological consequences of such overdoses are considered. The consequences are discussed in relation to the amount of the acid ingested. The problems likely to be encountered in the management of such patients are highlighted.
The importance of duodenal diverticula in the elderly
Authors: Pearce V R
Published: December 2008

All barium meal examinations performed, in patients aged greater than 65 years, in one year in one Health District are reviewed. There were 39 cases of duodenal diverticula. One case of osteomalacia and folate deficiency was discovered and this patient had evidence of small bowel bacterial overgrowth. In the remaining cases showing evidence of nutritional deficiency, other factors were probably responsible. The evidence for an association between deficiencies and duodenal diverticula is discussed, and it is concluded that these structures are rarely responsible for nutritional deficiencies in the elderly.
Adult bronchiolitis and parainfluenza type 2
Authors: O’Reilly John F
Published: December 2008

A case of acute bronchiolitis in association with parainfluenza type 2 infection is reported in a previously asymptomatic young adult with evidence of partially reversible severe airways obstruction.
Successful pregnancy soon after oral contraceptive-associated malignant hypertension
Authors: Silas J H , Singer A , Woods H F , Brown V A
Published: December 2008

A woman who developed malignant hypertension while taking a very low oestrogen oral contraceptive underwent an uncomplicated pregnancy conceived 3 months later. Her BP was well controlled with propranolol alone.
Pancreatic insufficiency following abdominal irradiation
Authors: Kingham J G , Barrett A
Published: December 2008

A case is reported of pancreatic insufficiency following abdominal irradiation for Hodgkin’s disease in a man aged 47 years. The effects of radiation on the pancreas are discussed. It is suggested that post irradiation steatorrhoea may have a pancreatic as well as an enteric cause.
The treatment of haemorrhoids by rubber band ligation at St Mark’s hospital
Authors: Jeffery P J , Ritchie S M , Miller W , Hawley P R
Published: December 2008

Two hundred and ninety-five patients with symptomatic haemorrhoids were treated by rubber band ligation as out-patients at St Mark’s Hospital, London, between April 1972 and December 1975. Follow-up was possible in 260 patients of whom two-thirds were satisfied with the outcome: 69 patients had residual symptoms for which no treatment had been sought. Nineteen patients eventually required a haemorrhoidectomy.
Trichogranulomatous mastopathy: an unusual cause of bleeding from the nipple
Authors: Goepel J R
Published: December 2008

A case of bleeding from the nipple is presented which was due to fragments of hair within breast ducts. It is suggested that these were accidentally introduced through the nipple.
Shigella septicaemia following renal transplantation
Authors: Severn M , Michael J
Published: December 2008

Two patients are described who developed septicaemia with Shigella flexneri following renal transplantation. Pre-operative screening had not identified either patient as a chronic carrier of Shigella sp. The acute management and problems posed by unrecognized carriers amongst patients undergoing transplantation in areas of the world where Shigella is endemic, are discussed.
Surgical presentation of small bowel lymphoma in adult coeliac disease
Authors: Finan P J , Thompson M R
Published: December 2008

A case of perforation of a small bowel lymphoma in a patient with coeliac disease is reported. Postoperative management was complicated by a large protein and fluid loss from the small bowel, rapidly controlled by treatment with corticosteroids. Attention is drawn, by briefly reviewing 11 other cases, to the ways in which small bowel lymphoma in patients with coeliac disease may present to the surgeon. Most patients who develop this complication of coeliac disease will die within 6 months of the diagnosis of small bowel lymphoma. Attention is drawn in this case to the rapidity with which the tumour grew and became disseminated.
Gold colitis, therapy and confirmation of mucosal recovery by measurement of rectal potential difference
Authors: Huston G J
Published: December 2008

A 38-year-old man with rheumatoid arthritis developed colitis after a course of 320 mg sodium aurothiomalate. Recovery comparable with that reported with corticosteroids or chelating agents was achieved by fluid replacement alone. Mucosal recovery was confirmed by measurement of rectal potential differences.
Prevalence of thyroid antibodies in Shiraz, Iran, an area with iodine deficiency
Authors: Khaleeli A A
Published: December 2008

The prevalence of thyroid antibodies was 2% among 53 healthy Shirazi volunteers, 3% among 30 consecutive patients with goitre, 41% among 17 patients with thyrotoxicosis and 67% among 18 consecutive patients with myxoedema. A surprising finding was that in a sub-group of 9 of the latter, a high incidence of diabetes (55%) was found and when both diseases co-existed, the prevalence of thyroid antibodies was 80% compared with 67% with myxoedema alone.

Serum cholesterol was marginally lower in the goitre than the control group (P, 0.05-0.025) but when females alone were compared there was no significant difference. It was also lower in the thyrotoxic group (P, 0.0025) and higher in the myxoedema group (P, 0.0025). Serum triiodothyronine was lower in the goitre group than the controls (P, 0.0005) but again, when females alone were considered, this difference lessened (P, 0.025-0.0125). Serum thyroxine and thyroid stimulating hormone levels showed no significant differences in the goitre and control groups.
Improvement in renal function in primary hyperparathyroidism following parathyroidectomy
Authors: Ghose R R , Morgan W D
Published: December 2008

Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were measured pre- and post-parathyroidectomy in 9 patients with primary hyperparathyroidism. Radiological studies had shown no sign of renal calculi or nephrocalcinosis in these patients. Before operation, GFR ranged from 98.5 to 23.4 ml/min/1.7 m2 and ERPF ranged from 510 to 127 ml/min/1.7 m2. After operation, GFR rose to a range of 108.8 to 48.7 ml/min/1.7 m2, and ERPF ranged from 556 to 189 ml/min/1.7 m2.

The results suggest that early diagnosis and surgery are important, both to prevent progressive renal damage and to improve the possibility of recovery where functional damage has occurred.