bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oesophageal tuberculosis: a review of eleven cases
Authors: Mokoena T , Shama D M , Ngakane H , Bryer J V 
Published: December 2008

Summary
Tuberculous infection of the oesophagus is rare. This is confirmed by our present review of cases managed in our teaching hospitals over a period of 18 years which uncovered only 11 patients. The main presentation is that of dysphagia whose algorithm of investigation should seek to differentiate tuberculosis from carcinoma, the more common cause of this symptom. Of the 11 patients, 9 presented with dysphagia while 2 had haemorrhage; 7 had an abnormal plain chest radiograph, of whom 4 had a mediastinal mass lesion (3 were lymphadenopathy and one an abscess). All but one had an abnormal radio-contrast oesophagogram, including a mediastinal sinus in two and a traction diverticulum in another two. The mainstay of investigation was oesophagoscopy through which diagnostic biopsy material was obtained in half of the patients. In the other half diagnosis was by either biopsy of associated mediastinal (3) or cervical (1) lymph node masses or by acid fast bacilli positive sputum (1). The diagnosis was established post-mortem in one patient.
Treatment was primarily non-operative with standard anti-tuberculosis drug therapy. Two patients underwent a diagnostic thoracotomy and one a drainage of mediastinal abscess together with resection and repair of oesophago-mediastinal sinus during the early part of the series. Outcome of management was very rewarding in 9 patients and death occurred in 2 patients, one of whom had his anti-tuberculosis drug therapy interrupted by severe hepatitis B virus infection. The other death occurred in a patient whose haemorrhage from an aorta-oesophageal fistula was not established ante-mortem. It is recommended that when biopsy material of the oesophagus is unobtainable or non-diagnostic in patients with dysphagia, especially with an abnormal chest radiograph or human immunodeficiency virus infection, effort should be made to obtain biopsy material from associated lymph nodes, even by thoracotomy if necessary, or culture of biopsy from the radiologically abnormal part oesophagus and sputum for mycobacteria, in order to establish the diagnosis of this rare but eminently treatable cause of dysphagia. Clinicians should be aware of tuberculosis of the oesophagus as a possible cause of haematemesis in patients with otherwise unexplained upper gastrointestinal haemorrhage.
Epilepsy--another cause of intermittent fever with confusion
Authors: Chan K M 
Published: December 2008

Summary
The problem of recurring episodes of fever and confusion in an 83 year old man was found to be due to epilepsy. He was treated with carbamazepine which abolished the attacks. Epilepsy-induced fever is a difficult diagnosis to make, and electroencephalogram can be invaluable in making the diagnosis.
Primary pericardial mesothelioma presenting as tuberculous pericarditis
Authors: Rose D S C , Vigneswaran W T , Bovill B A , Riordan J F , Sapsford R N , Stanbridge R DeL 
Published: December 2008

Summary
Ante-mortem diagnosis of primary pericardial mesothelioma is very rare. We report a case which presented clinically as tuberculous constrictive pericarditis. The patient underwent pericardial resection with an immediate haemodynamic benefit, although the malignant process progressed, and he died 14 weeks later.
NonEBV-related B-cell lymphoma in a renal transplant patient responding to acyclovir and reduction in immunosuppression
Authors: Wong R C W , Harrison P 
Published: December 2008

Summary
A case of polyclonal B-cell pharyngeal lymphoma in a renal transplant patient is reported. No evidence of Epstein-Barr virus involvement was detected, but the lymphoma underwent complete remission with acyclovir and reduction in immunosuppression.
Is Asacol as effective as sulphasalazine in maintaining remission of Crohn's disease and ulcerative colitis?
Authors: Nakshabendi Imad M , Duncan Andrew , Russell Robin I 
Published: December 2008

Summary
To compare the efficacy of Asacol (mesalazine coated with Eudraget-S) as a maintenance therapy with that of sulphasalazine, relapse rates of patients with ulcerative colitis and Crohn's disease, treated with sulphasalazine or Asacol were assessed in a retrospective study. A total of 164 patients were investigated, 127 on sulphasalazine and 37 on Asacol. None of the patients on Asacol was changed from sulphasalazine because of lack of efficacy to sulphasalazine. Relapse rates were measured over a 4 year period. In ulcerative colitis these were sulphasalazine 10/77 (13.0%), Asacol 5/20 (25.0%), NS; in all Crohn's disease patients, sulphasalazine 12/50 (24.0%), Asacol 11/17 (64.7%); P less than 0.0025. In patients with Crohn's disease with ileal involvement, relapse rates were sulphasalazine 9/28 (32.1%), Asacol 9/11 (81.6%), P less than 0.0125; without ileal involvement, sulphasalazine 3/22 (13.6%), Asacol 2/6 (33.4%), NS.
This study suggests that Asacol is as effective as sulphasalazine in maintaining remission in ulcerative colitis and in patients with Crohn's disease without ileal involvement. Sulphasalazine seems to be more effective than Asacol in maintaining remission in patients with Crohn's disease with terminal ileal involvement.
Adult metachromatic leukodystrophy with an unusual relapsing-remitting course
Authors: Sadeh Menachem , Kuritzky Arieh , Ben-David Eitan , Goldhammer Yochanan 
Published: December 2008

Summary
A 46 year old woman had a relapsing-remitting course of hemiparesis, disorientation, paraparesis and seizures, followed by progressive dementia, spasticity and ataxia. Computed tomography at onset showed a parietotemporal hypodense area with diffuse mottled enhancement obliterating the lateral ventricle. Subsequent scans demonstrated symmetric periventricular non-enhancing hypodensities, progressive ventricular enlargement and atrophy. Adult metachromatic leukodystrophy was diagnosed on the basis of low leukocyte arylsulphatase A level and metachromatic material accumulation at neural nerve biopsy.
Recovery of adrenocortical function following treatment of tuberculous Addison's disease
Authors: Penrice Juliet , Nussey S S 
Published: December 2008

Summary
We report two cases of Addison's disease occurring in association with proven Mycobacterium tuberculosis infection. Both were treated with modern chemotherapeutic agents and were shown to have developed normal adrenal cortical function after several years. We suggest that adrenal function should be tested after modern anti-tuberculous therapy of this disease.
Use of the SeHCAT test in the investigation of diarrhoea
Authors: Ford G A , Preece J D , Davies I H , Wilkinson S P 
Published: December 2008

Summary
The SeHCAT test was used to investigate possible bile acid malabsorption in 166 patients presenting to a district general hospital with chronic diarrhoea of uncertain cause. Eighty-four (51%) patients had impaired SeHCAT retention. These included 23 of 28 patients with a possible type I abnormality (terminal ileal resection or disease, previous pelvic radiotherapy), 20 of 74 with a possible type II abnormality (idiopathic diarrhoea), 32 of 45 with a possible type III abnormality (post-cholecystectomy, post-vagotomy), and 9 of 19 with diarrhoea associated with diabetes. Patients with severe bile acid malabsorption demonstrated a good response to cholestyramine whereas the response in patients with a mildly abnormal SeHCAT retention was variable. Bile acid malabsorption is an important cause of diarrhoea in patients presenting with unexplained chronic diarrhoea.
Falciparum malaria-induced hypoglycaemia in a diabetic patient
Authors: Shalev Oded , Tsur Anat , Rahav Galia 
Published: December 2008

Summary
We report a patient with diabetes mellitus who suffered severe falciparum malaria complicated by profound and persistent hypoglycaemia. The hypoglycaemia evolved before therapy with quinine was begun and resolved with eradication of the parasitaemia. The patient reverted to her baseline hyperglycaemia despite continuation of quinine. This case illustrates the critical role of falciparum malaria in the pathogenesis of malaria-associated hypoglycaemia, rather than quinine-mediated mechanisms. Anticipation of hypoglycaemia in falciparum malaria and its vigorous treatment may improve the poor prognosis associated with this complication.
Lymphomatoid granulomatosis presenting as angioedema
Authors: Torrelo Antonio , Martín Manuel , Rocamora Antonio , Allegue Francisco , Ledo Antonio 
Published: December 2008

Summary
We describe a patient with severe eyelid and lip angioedema lesions in whom biopsy specimens from angioedematous labial mucosa disclosed features of lymphomatoid granulomatosis. To our knowledge, angioedema lesions with characteristic histological findings of lymphomatoid granulomatosis have not been previously described as a presenting sign of this disease.
A case of polycythaemia vera presenting with intramuscular chest wall haematoma
Authors: Kheterpal S , Sayegh F , Cader A 
Published: December 2008

Summary
A 40 year old male, previously well, presented with a posterior chest wall haematoma. Computerized tomography and ultrasound showed this to be intramuscular. Haematological indices were consistent with a diagnosis of polycythaemia vera. The haematoma and indices responded to hydroxyurea and venesection. This rare presentation of polycythaemia vera in a young person is described and the haemorrhagic complications of polycythaemia vera discussed.
The role of faecal Candida albicans in the pathogenesis of food-intolerant irritable bowel syndrome
Authors: Middleton S. J. , Coley A. , Hunter J. O. 
Published: December 2008

Summary
Candida albicans was sought in stool samples from 38 patients with irritable bowel syndrome and 20 healthy controls. In only three patients with irritable bowel syndrome was C. albicans discovered and these patients had either recently received antibiotics or the stool sample had been delayed more than 24 hours in transit. C. albicans was isolated from none of the control stool samples. We conclude that C. albicans is not involved in the aetiology of the irritable bowel syndrome.
Endoscopic therapy for bile duct stones in a geriatric population
Authors: Croker John R. , Williams Simon G. , Charlton Michael , Vaira Dino , Dowsett John 
Published: December 2008

Summary
During the 5 year period to May 1988, 137 consecutive patients (age range, 65-102 years; median 84 years) with a diagnosis of choledocholithiasis, were referred to The Middlesex Hospital Geriatric Department. Endoscopic sphincterotomy was successful in 96.2% of cases and immediate biliary drainage was achieved in all but one of these patients. Stones were cleared endoscopically in 73.3% and surgically in 4.7% of cases. Long-term stenting was employed in 14.3% of patients. The 30 day mortality after endoscopic or surgical treatment was 4.7% (six deaths), although death was probably unrelated to therapy in half the cases. Deaths were due to procedural cardiorespiratory arrest (1), pancreatitis (1), pneumonia (2) and cerebrovascular accident (2). Endoscopic treatment is effective even in a high-risk geriatric population. After sphincterotomy patients with intact gall bladders should be managed expectantly.
Non-secretory multiple myeloma presenting as primary plasma cell leukaemia
Authors: Sureda A. , Pais J. R. , Pascual J. , Pérez Vaquero M. A. , Hernando J. C. 
Published: December 2008

SummaryA case of non-secretory multiple myeloma presenting as primary plasma cell leukaemia in a 65 year old woman is presented. Bone pain was the initial clinical manifestation. Laboratory analysis showed 20% of circulating immature plasma cells. Despite the presence of osteolytic lesions, no M-component could be demonstrated in serum protein electrophoresis, and serum and urine immunoelectrophoresis. Bone marrow aspirate demonstrated an 83% infiltration of plasma cells showing various degrees of immaturity. Immunofluorescence with monoclonal antisera demonstrated intracytoplasmic kappa light chains in a high percentage of plasma cells. Immature plasma cells without cellular capacity to synthesize and excrete complete immunoglobulins could be more aggressive, leading to an initial leukaemic process. Previous work regarding possible pathogenetic mechanisms, clinical and laboratory features, and response to treatment of this extremely rare association are reviewed.
Acute intermittent porphyria treated by testosterone implant
Authors: Savage M. W. , Reed P. , Orrman-Rossiter S. L. , Weinkove C. , Anderson D. C. 
Published: December 2008

Summary
The hereditary disorder acute intermittent porphyria is potentially fatal. Many more females present with active disease than males and some have attacks related to their menstrual cycle and pregnancy. We present a female patient who was diagnosed while pregnant at 19 years. She subsequently developed life-threatening attacks pre-menstrually at 24 years; these were associated with weight loss. Initial treatment was with high calorie feeding via a naso-gastric tube, followed by a gastrostomy. Subsequent gonadotrophin suppression with intranasal luteinizing hormone-releasing hormone analogue (buserelin) thrice daily met with limited success. We implanted 100 mg of testosterone subcutaneously in November 1989. The buserelin was discontinued in January 1990 and menses returned 3 months later. There have been no serious attacks since then. Repeat implantation was performed at 6 monthly intervals until her present pregnancy. Baseline biochemical parameters have remained high and unaltered despite treatment although the testosterone has clearly had a marked clinical benefit, without side effects.
Behçet's syndrome in Scotland
Authors: Jankowski J , Crombie I , Jankowski R 
Published: December 2008

Summary
We present the clinical details and HLA typing of 15 Celtic Caucasian patients (four male, 11 female) with Behçet's syndrome (International Study Group criteria). The males affected were younger than the affected females, and three of these males had severe uveal involvement. Two of the 15 patients had the A2 Bw6 Dr4 haplotype but this did not confer family penetrance. Eight had gastrointestinal involvement: two females required ileostomy, two females had chronic diarrhoea, one female had severe ileitis and oesophageal lesions, two males had peptic ulcers, and one female had a peptic ulcer and primary biliary cirrhosis. All of those who developed gastrointestinal symptoms had either the Dr4 or the Dr7 antigens. This study is the largest HLA survey of Celtic Caucasians with Behçet's syndrome. The clinical features and HLA haplotypes are markedly different from 'Arab' and 'Japanese' varieties of Behçet's syndrome. The expression of the Dr4 and Dr7 antigens in those with gastrointestinal involvement possibly implicates class II antigens (Dr) in the pathogenesis of the manifestations of Behçet's disease in the bowel.
Empty sella developing during thyroxine therapy in a patient with primary hypothyroidism and hyperprolactinaemia
Authors: Kelestimur Fahrettin , Selçuklu Ahmet , Ozcan Nevzat 
Published: December 2008

Summary
A 35 year old woman presented with severe primary hypothyroidism and galactorrhea. A very high prolactin level was also detected and computerized tomography scan of the sellar region demonstrated an enlarged pituitary gland associated with contrast enhancement. Replacement therapy with thyroxine corrected both biochemical and clinical abnormalities but empty sella developed during this therapy. It is concluded that empty sella may be related to thyroxine-induced shrinkage of lactotroph and/or thyrotroph cell hyperplasia.
Stroke in adult polycystic kidney disease
Authors: Rivera Maite , Gonzalo Ana , Gobernado José M , Orte Luis , Quereda Carlos , Ortuño Joaquin 
Published: December 2008

Summary
In order to assess the incidence of acute cerebrovascular events, 142 patients with adult polycystic kidney disease were retrospectively reviewed. Fourteen patients (9.8%) had 19 cerebral attacks. Six patients (4.2%) had intracranial haemorrhage attacks (three ruptured intracranial aneurysms and three cerebral haemorrhages). Ischaemic events occurred in nine patients (five cerebral infarctions and four transient ischaemic attacks). Patients with ischaemic attacks had a better outcome than patients with haemorrhagic events even when transient ischaemic attacks were excluded. Patients with ruptured intracranial aneurysms were younger. Cerebral complications are an important cause of morbidity and mortality in patients with adult polycystic kidney disease. They can prove disabling prior to or after dialysis and transplantation.
Absence of potentiation of the skin response to intradermal bradykinin by a long-acting angiotensin converting enzyme inhibitor, trandolapril, at conventional antihypertensive dosage in human volunteers: a double-blind, randomized, cross-over, placebo-controlled trial
Authors: Li Kam Wa T C , Cooke E D , Beacham Julie , Turner P 
Published: December 2008

Summary
A double-blind, randomized, cross-over, placebo-controlled study was carried out to determine the extent and duration of potentiation of the action of bradykinin introduced intradermally by a long-acting novel angiotensin converting enzyme (ACE) inhibitor, trandolapril. The investigations were performed in a temperature and humidity-controlled laboratory. Intradermal injections of 1 microgram, 2.5 micrograms and 5 micrograms of bradykinin and normal saline (as control) were made into the forearm skin of eight healthy normotensive male volunteers aged 21-33 years (mean 28 years) at baseline, 2, 4, 8, 24, 48, 72 and 96 hours after either 2 mg trandolapril or placebo given orally. Skin blood flow outside the induced weal was monitored by laser Doppler flowmetry (mean of recordings at four sites adjacent to the weal within the flare area). Flare area and weal volume were also measured.
Trandolapril reduced the mean arterial pressure. However, there was no evidence that this activity was associated with a potentiation of the cutaneous action of bradykinin.
In conclusion, it would appear that potentiation of the action of bradykinin may not be an important contributing factor to the fall in total peripheral vascular resistance associated with ACE inhibition in humans in the control of hypertension.
Safe use of streptokinase in myocardial infarction in patients aged 75 and over
Authors: Kafetz Kalman , Luder Robert 
Published: December 2008

Summary
We have given streptokinase to 73 patients aged 75 and over admitted to medical admission wards for elderly people using strict exclusion criteria. This was safe and free from significant adverse events by comparison with other studies. The average age of the patients was 78.2 years so they formed a relatively young group compared with all patients over 75. There was a relatively long delay between presentation at the hospital and receipt of treatment.
Intracerebral haemorrhage after thrombolytic therapy for acute myocardial infarction
Authors: More R S , Vincent R 
Published: December 2008

Summary
Seven cases of intracerebral haemorrhage were identified following the use of thrombolytic therapy in a total of 710 patients with acute myocardial infarction. Each case was reviewed in detail with particular attention to the presenting symptoms. A confusional state was the commonest initial feature. Increased age and male sex were associated with increased risk of cerebral bleed. The possible role of intravenous heparin in increasing risk and the management of affected cases is discussed. Early recognition and action is emphasized.
Severity of alcoholic liver disease and markers of thyroid and steroid status
Authors: Burra P , Franklyn J A , Ramsden D B , Elias E , Sheppard M C 
Published: December 2008

SummaryAlcoholic liver disease is associated with abnormalities in circulating levels of thyroid, adrenal and gonadal steroid hormones. The relative importance of ethanol consumption and severity of liver disease in the aetiology of these changes and their relationship to clinical abnormalities are unclear. We studied 31 subjects with alcohol-induced liver disease divided into three groups according to the severity of histological features: fatty change, hepatitis and cirrhosis.Circulating concentrations of thyroid, adrenal and gonadal steroid hormones, together with their major binding proteins, were measured in all subjects, and changes related to histology and tests of liver function, as well as clinical endocrine status. A reduction in circulating free tri-iodothyronine (fT3) was seen in subjects with alcoholic hepatitis and cirrhosis, in association with normal or reduced levels of thyrotrophin (TSH).The absence of abnormalities in subjects with fatty change despite similar ethanol intake to the other groups, and correlations between fT3 and liver function tests, suggest that changes in fT3 reflect the severity of underlying liver disease. Similarly, marked increases in circulating cortisol in the hepatitis and cirrhosis groups, and correlations between cortisol and liver function, suggest that changes largely reflect hepatic disease. The absence of clinical features of hypothyroidism or Cushing's syndrome in these groups, despite abnormalities of fT3 and cortisol, suggest an altered tissue sensitivity to hormone effects. In contrast, increases in circulating oestradiol and reductions in testosterone were found in all three groups in males. These findings suggest that both direct effects of ethanol and hepatic dysfunction determine changes in gonadal steroids in males.
Neuromuscular disease, respiratory failure and cor pulmonale
Authors: White John , Bullock R E , Hudgson P , Gibson G J 
Published: December 2008

Summary
Respiratory muscle weakness is an uncommon cause of chronic respiratory failure and a rare cause of cor pulmonale. The problem may not be apparent unless specific physical signs are sought or appropriate investigations performed. We present three patients who presented diagnostic difficulty for prolonged periods until the presence of respiratory muscle weakness was considered. Once the diagnosis was established treatment with nocturnal nasal intermittent positive pressure ventilation produced a dramatic improvement in symptoms and allowed a return to a near normal lifestyle.
Brucellosis with nephrotic syndrome, nephritis and IgA nephropathy
Authors: Siegelmann Nava , Abraham Abraham S , Rudensky Bernard , Shemesh Ovadia 
Published: December 2008

Summary
A patient with systemic brucellosis due to Brucella melitensis had severe renal involvement. Clinical features included hypertension, macroscopic haematuria, massive proteinuria of 10 g per 24 hours and azotaemia. Following treatment with antibiotics, the azotaemia resolved and proteinuria decreased to less than 0.5 g per 24 hours, but microscopic haematuria and hypertension persisted. Renal biopsy during recovery revealed IgA nephropathy with minimal mesangial changes, suggesting a causal relation between brucellosis and IgA nephropathy with a reversible nephrotic syndrome.
Further evidence for differential regulation of follicle-stimulating hormone (FSH) and luteinizing hormone (LH): increased FSH and decreased LH levels in a patient with familial pure gonadal dysgenesis
Authors: Popovic V , Micic D , Damjanovic S , Calovic L J , Rolovic Z , Mijovic A , Petakov M , Manojlovic D , Micic J 
Published: December 2008

Summary
There is experimental evidence that a portion of follicle-stimulating hormone (FSH) secretion is independent of hypothalamic influences. A 29 year old woman with familial pure gonadal dysgenesis developed myelodysplastic syndrome. Endocrine investigations showed discrepancy between serum FSH and luteinizing hormone (LH) levels. FSH levels remained elevated while LH levels decreased. The FSH to LH ratio was 10 (normal 2-2.5). The fall in LH is likely to be due to factor(s) involved directly and specifically in LH synthesis and release. Exogenous LH releasing hormone administration as well as hormonal replacement treatment increased LH levels. The FSH to LH ratio decreased to 7. This case supports the hypothesis of differential regulation of FSH and LH, and that FSH secretion is at least partly autonomous.