bluuebunny/crossref_metadata_2025_split huggingface dataset:
Problems of myeloma in a community
Authors: Flanagan N G , Ridway J C , Jain A , Platt C C , Irving A G 
Published: December 2008

Summary
The presenting features of 120 consecutive cases of myeloma diagnosed in a single unit were examined. Screening tests on routine laboratory samples increased the detection rate but did not significantly reduce the percentage of cases presenting with late stage disease. Morbidity was closely related to the incidence of bone involvement already present at diagnosis. About one fifth of cases had reported suspicious symptoms for some considerable time before further investigation was forthcoming. Almost half had ‘benefitted’ by having concurrent disease which often led to the discovery of myeloma at an early stage. These findings, together with the wide variety of symptomatology and few physical signs, stressed the critical importance of having a high index of suspicion and thus taking suitable blood samples without unnecessary delay.
A novel means of comparing the bioequivalence of two formulations of tripotassium dicitrato bismuthate (De-Noltab)
Authors: Coghill S B , Shepherd A N 
Published: December 2008

Summary
Tripotassium dicitrato-bismuthate (TDB) has a topical action in the upper gastrointestinal tract. Absorption is minimal and the blood levels are therefore irrelevant to the assessment of bioavailability. TDB is however detectable in the stomach and duodenum by conventional electron microscopy. Following oral administration of two different formulations of TDB tables to patients attending a gastroscopy clinic, duodenal biopsies were obtained and examined by electron microscopy. The amount of electron dense drug precipitate was quantified. No difference could be detected between the two formulations.
Oral bowel lavage preparation for colonoscopy
Authors: Burke D A , Manning A P , Murphy L , Axon A T R 
Published: December 2008

Summary
Colonoscopy is a commonly performed diagnostic and therapeutic procedure in most general hospitals, which requires effective bowel preparation to be worthwhile. We report the effect of replacing a diet, laxative and bowel washout preparation with oral bowel lavage using a balanced electrolyte formulation, in our unit. The preparation was acceptable to patients, medical and nursing staff, generally preferred to previous preparations by those who had experienced them, allowed a more complete colonoscopy with an excellent quality of view, and was less expensive in nursing time. We regard oral bowel lavage as currently the method of choice for bowel preparation prior to colonoscopy in the majority of patients.
Pulmonary endometriosis mimicking an acute abdomen
Authors: Grunewald R A , Wiggins J 
Published: December 2008

Summary
A case of pulmonary endometriosis is reported, to illustrate the classic catamenial symptoms of the disease. The patient also developed symptoms and signs suggesting a perforated abdominal viscus; laparotomy was normal and the features may have resulted from a previously unreported effect of diaphragmatic endometrial foci.
Retinal pigment epithelial change and partial lipodystrophy
Authors: Davis T M E , Holdright D R , Schulenberg W E , Turner R C , Joplin G F 
Published: December 2008

Summary
Cuticular drusen and retinal pigment epithelial changes were found incidentally in a 27 year old Lebanese woman during assessment of partial lipodystrophy. Her vision was normal despite involvement of both maculae. The patient had hypocomplementaemia, but serum C3 nephritic factor was absent and renal function was normal. She had impaired glucose tolerance and a continuous infusion of glucose with model assessment (CIGMA) test revealed low normal tissue insulin sensitivity and high normal pancreatic beta cell function. Mild fasting hypertriglyceridaemia (2.0 mmol/l) may have been secondary to impaired insulin sensitivity. Endocrine function was otherwise normal apart from a completely absent growth hormone response to adequate hypoglycaemia. The simultaneous occurrence of partial lipodystrophy and retinal pigmentary epithelial and basement membrane changes appears to be a newly recognized syndrome.
The skull in chronic sarcoidosis
Authors: Landsberger D , Rav’e D , Friedman G 
Published: December 2008

Summary
A report of a 63 year old woman with giant osteolytic skull lesions simulating metastatic disease, and generalized cutaneous lesions is presented. Biopsy of a skin lesion revealed non-caseating granulomas compatible with sarcoidosis. The literature dealing with calvarial sarcoidosis is reviewed.
Systemic sclerosis in association with multiple primary pulmonary malignancy--a marker of internal malignancy?
Authors: Goodfield M J D , Millard L G 
Published: December 2008

Summary
Multiple pulmonary malignancy is uncommon and has not been reported in association with systemic sclerosis. We now report such a case in which it is likely that the connective tissue disease occurred as a marker of the internal malignancy. Systemic sclerosis is not generally a reliable indicator of malignant change, but it is possible that in patients who are immunosuppressed, either therapeutically or inherently, the onset of systemic sclerosis should prompt investigation for an underlying cause.
Nature, incidence and prognosis of neurological involvement in the acquired immunodeficiency syndrome in central London
Authors: Guiloff R J , Fuller G N , Roberts A , Hargreaves M , Gazzard B , Scaravilli F , Harcourt-Webster J N 
Published: December 2008

Summary
Clinical neurological involvement at various times throughout the illness was recorded in 52% of 122 patients seen in central London who died from acquired immunodeficiency syndrome (AIDS). Various metabolic encephalopathies, dementias, focal encephalopathies, retinopathies and peripheral nerve pathology were the most frequent manifestations. Seven of 9 patients with a neurological presentation had no other major systemic illness. The median time from diagnosis of AIDS to death was 9 months and from onset of neurological symptoms to death 4 months. Human immunodeficiency virus dementia, central nervous system opportunistic infections, presence of Kaposi sarcoma, neurological presentations and minor symptoms were not associated with major change in survival time.
Beta-blockers, lipoproteins and non-insulin dependent diabetes
Authors: Feher M D , Rains S G H , Richmond W , Torrens D , Wilson G , Wadsworth J , Sever P S , Elkeles R S 
Published: December 2008

Summary
In a study on 138 hypertensive non-insulin dependent diabetic subjects, factors influencing lipoproteins were assessed. Multiple regression analyses were carried out in order to assess the influence of beta-blocker antihypertensive therapy while making allowances for other confounding variables. In males, but not in females, on a beta-blocker for hypertension, total high density lipoprotein- (HDL-) and HDL-subfraction cholesterol were significantly lower while the serum triglyceride was increased, though not significantly. In male non-insulin dependent diabetics, regimens containing a beta-blocker may worsen an already abnormal lipoprotein profile and antihypertensive agents other than beta-blocking agents should be used if possible.
Studies on the mechanism of non-visualization of diseased human gallbladders during oral cholecystography
Authors: Jacyna M R , Ross P E , Hopwood D , Bouchier I A D 
Published: December 2008

Summary
Oral cholecystography is a well established method for studying the human gallbladder and radiological non-visualization of the gallbladder has been shown to correlate highly with the presence of disease. The exact mechanism by which diseased gallbladders fail to visualize is unclear, but may be due to a failure of the gallbladder to concentrate the luminal contents. Concentration of gallbladder contents is achieved by the reabsorption of water, the driving force for which is active sodium (Na+) absorption. Therefore Na+ transport was studied by measuring the flux of Na22 across isolated human gallbladder mucosa (obtained at cholecystectomy) and compared with the results of oral cholecystography and histological grading. In 27 gallbladders studied, 59% absorbed Na+, whilst the remainder secreted Na+. Comparison with histological grading showed that as gallbladders became more diseased they absorbed less Na+ and were more likely to secrete Na+. In addition, gallbladders that absorbed Na+ were significantly more likely to visualize on cholecystography than those that secreted Na+. These results indicate that some diseased human gallbladders secrete, rather than absorb, Na+ and suggest that the mechanism for radiological non-visualization is failure of fluid absorption and the development of active fluid secretion.
Spontaneous tension pyopneumopericardium--a case with recovery after surgery
Authors: Bilbao-Garay J , Carreño M C , Roman F , Perez-Maestu R , Masa-Vazquez C , de Letona J M 
Published: December 2008

Summary
Tension pyopneumopericardium is a rare condition with a very high mortality. The majority of cases are due to perforation of oesophagus or bronchi into the pericardial cavity. We report a patient with spontaneous pyopneumopericardium who survived with antibiotic treatment and surgical drainage.
Scarlet fever can mimic toxic shock syndrome
Authors: Brook M G , Bannister B A 
Published: December 2008

Summary
We describe a patient who presented with a widespread erythematous rash, diarrhoea, confusion, pre-renal uraemia and hyponatraemia. The diagnosis of staphylococcal toxic shock syndrome seemed likely as she was menstruating and there was no evidence of pharyngitis. A rising ASO titre confirmed a streptococcal aetiology and thus ‘toxic’ scarlet fever. Toxic shock syndrome and toxic scarlet fever are compared.
Myocardial infarction: a complication of amitriptyline overdose
Authors: Chamsi-Pasha H , Barnes P C 
Published: December 2008

SummaryA 22 year old woman was admitted with amitriptyline overdose. Twenty six hours later she developed acute myocardial infarction. Cardiotoxic effects of tricyclic antidepressants are discussed and the importance of considering myocardial infarction as a complication of tricyclic antidepressant overdose is emphasized.
When to advise surgery for severe obesity
Authors: Garrow J S 
Published: December 2008

Summary
A typical severely obese patient will have about 50 kg excess weight to lose, which is equivalent to a store of 350,000 kcal. The optimum rate of weight loss in such a patient is about 1 kg/week, which involves an energy deficit of 1000 kcal/day for about a year. It is difficult to maintain this degree of dietary restriction over such a long period, and procedures such as jaw wiring or stomach stapling may help in some cases. Maintenance of weight loss is difficult to achieve and may be helped by fitting a nylon waist cord after weight loss. On theoretical grounds, patients who do not lose weight despite keeping to a properly-designed reducing diet would not benefit from surgery, but in practice this problem does not arise. It is dangerous to resort to surgery for the treatment of severely obese patients who cannot diet by reason of psychiatric disorder.
Renal metastases shown by 99mTc-methylene diphosphonate scintigram which failed to detect vertebral metastases
Authors: Kreel L , Thornton A , Stewart I 
Published: December 2008

Summary
A patient with breast metastases is presented showing increased nodular renal uptake of tracer on bone scintigraphy that also demonstrated rib metastases and a large metastasis in the pelvis. However, vertebral body metastases were not shown when clearly demonstrated on CT with even partial compression on a thoracic spine film. Most of the renal lesions were hypoechoic on sonography, showed hypoattenuation areas on plain CT and after contrast enhancement but no calcification could be demonstrated. This case once again illustrates the value of scrutinizing the soft tissues on scintigraphy but also the possibility of showing some metastases on CT not visible on scintigraphy.
Unusual presentation of a large pituitary tumour in relation to diving
Authors: Bakheit A M , Kennedy P G E 
Published: December 2008

Summary
A case of necrosis of a pituitary tumour occurring in the context of diving is described. The presenting features and subsequent course suggested a brain stem vascular event. The tumour was not detected by routine computerized tomographic scanning, but was identified with magnetic resonance imaging. The possible pathophysiological mechanism is discussed.
Diabetes insipidus complicating myelofibrosis
Authors: Dornan T L , Gillett G , Jones P A E , Jeffcoate W J 
Published: December 2008

Summary
A 68 year old man developed cranial diabetes insipidus 3 years after the diagnosis of myelofibrosis, coincident with a marked increase in nucleated cell count. No mass lesion was demonstrable on computed tomographic or magnetic resonance imaging. It is suggested that hypothalamic damage was caused by local infiltration or infarction, a complication of myelofibrosis which has not previously been reported.
Thrombophlebitis migrans following co-trimoxazole therapy
Authors: Verne-Pignatelli J , Spickett G P , Dalgleish A G , Denman A M 
Published: December 2008

Summary
We report an unusual and severe vasculitic disorder following co-trimoxazole, given orally for a urinary tract infection. The vasculitis was manifest solely as thrombophlebitis migrans and involving only veins without evidence of polyarteritis nodosa, or underlying malignancy.
Intermittent omental torsion--an unusual cause of recurrent abdominal pain?
Authors: Parr N J , Crosbie R B 
Published: December 2008

Abstract
A case of haemoperitoneum arising from an omental haematoma is described. Histology suggests that this resulted from an omental torsion. The omentum, however, was not torted at the time of laparotomy. Furthermore, there was a history of similar episodes of pain over the previous eighteen months. This suggests that spontaneous derotation of an omental torsion may occur, and may be an unusual cause of recurrent abdominal pain.
Aortobronchial fistula: an uncommon cause of haemoptysis
Authors: Riancho J A , Gutiérrez J A , Echevarría S , Daroca R , González Macías J 
Published: December 2008

Summary
A 16 year old patient who presented with haemoptysis as the main manifestation of the infection of an aortic patch graft is reported. The importance of being alert about the possibility of an aortobronchial fistula in patients with haemoptysis who have been previously subjected to cardiovascular surgery is emphasized.
Haemochromatosis and aldosterone deficiency presenting with Yersinia pseudotuberculosis septicaemia
Authors: Conway S P , Dudley N , Sheridan P , Ross H 
Published: December 2008

Summary
A 50 year old man presented with a pyrexial illness following a holiday abroad. Yersinia pseudotuberculosis was isolated from blood culture. Response to appropriate antibiotic therapy was prompt and complete, but full recovery was complicated by an episode of hyperkalaemia, hyponatraemia and the passing of large volumes of dilute urine. Three years previously he had developed diabetes mellitus and hypogonadotrophic hypogonadism. Investigation on recovery showed underlying haemochromatosis and aldosterone deficiency.
Functional, malignant intrathoracic paraganglioma
Authors: Aggarwal P , Wali J P , Venugopal P , Khosla A , Tickoo S K 
Published: December 2008

Summary
This paper describes a case of functional, malignant branchiomeric paraganglioma, the third such to be reported. The patient presented with malignant hypertension and symptoms suggestive of excessive catecholamine secretion.
Hypercalcaemia in association with enteric fever
Authors: Connolly M J , Snow M H , Farndon J R 
Published: December 2008

Summary
We report 2 cases of hypercalcaemia and hypercalciuria, with detectable levels of parathyroid hormone, which appeared to be precipitated by enteric fever. Extensive investigation of one case, including ultrasound, isotope scanning, angiography, computed tomographic scanning and surgical exploration, failed to detect a parathyroid adenoma. In both cases biochemical and hormonal abnormalities resolved several months after recovery of enteric fever. The mechanism of the proposed association is unexplained but it should be considered in any patient with hypercalcaemia and detectable parathyroid hormone levels, who is suffering from or has recently recovered from enteric fever. If such a patient is well, a period of several month’s observation is recommended. We believe these two cases to be the first such reports of hypercalcaemia in association with enteric fever.
Treatment of multiple subcutaneous Nocardia asteroides abscesses with ciprofloxacin and doxycycline
Authors: Bath P M W , Pettingale K W , Wade J 
Published: December 2008

Summary
We report on the successful use of oral ciprofloxacin and doxycycline in the treatment of multiple subcutaneous nocardial abscesses in an immunocompromised patient with active non-Hodgkin’s lymphoma. This relatively inexpensive regimen allowed the patient to return home and was not associated with any significant side effects. The patient has shown no sign of relapse of her nocardial infection over an 8-month period on the above regimen.
Congenital absence of the intrahepatic segment of the inferior vena cava with azygos continuation presenting as a mediastinal mass
Authors: Beedie R J , Yeo W , Morcos S K 
Published: December 2008

Summary
A child with the isolated anomaly of azygos continuation of the inferior vena cava is presented. The interest of this abnormality lies in its detection as a mediastinal mass on the chest radiograph. Computed tomography with intravenous contrast enhancement is the method of choice to diagnose this venous anomaly. Awareness of the caval-azygos abnormality is important to surgeons and cardiologists. Accidental ligation of the azygos vein is fatal and cardiac catheterization using the lower extremity vein is troublesome in patients with this condition.
Confusional state and cerebral infarcts
Authors: García-Albea E 
Published: December 2008

Summary
Thirteen patients with confusional state and cerebral infarction were studied. Seven patients had optic pathway alterations. On computed tomographic scan, 2 patients had multiple infarctions and 10 had single infarctions, predominantly located in the temporo-occipital associative cortex. One patient had a normal scan. Reduction of ‘selective attention’, ‘release’ hallucinations, amnesic syndrome and secondary individual adjustment could explain the confusional state.
Lymphoplasmacytoid lymphoma elaborating lambda chain paraprotein with amyloid deposition in Sjögren’s syndrome
Authors: Savage A W G , Shareef D S , Maher E J , Bennett M H , Thomas D J B 
Published: December 2008

Summary
A woman presented with painful enlargement of her parotid and submandibular glands. She was shown to have the previously unreported combination of idiopathic thrombocytopenic purpura, Sjögren’s syndrome, Hashimoto’s disease, and myasthenia gravis. Parotid gland biopsy and bone marrow examination showed the presence of a rare lymphoplasmacytoid lymphoma. There was amyloid deposition in the parotid glands, gums and on muscle biopsy. Immunohistochemical staining of the parotid lymphoma and amyloid was monotypic for lambda light chains, and there was also a lambda chain paraprotein. It is felt that the lymphoplasmacytic lymphoma was responsible for the light chain amyloidosis.
Mediastinal carcinoid tumour with unusual manifestations
Authors: Aggarwal P , Sharma S K , Chattopadhyay T K , Mukhopadhyay A K 
Published: December 2008

Summary
A rare case of mediastinal carcinoid tumour with superior vena cava obstruction, and osteolytic as well as osteoblastic secondaries in the bones is described. The relevant literature is reviewed.
Use of somatostatin in the management of pancreatic haemobilia
Authors: Tobin M V , Jenkins S A , Gosney J R , Gilmore I T 
Published: December 2008

Summary
An elderly man, not previously known to have chronic pancreatitis, presented with haematemesis and melaena which was endoscopically diagnosed as haemobilia. Retrograde cholangiopancreatography showed blood clot in both the common bile duct and the pancreatic duct and the computed tomographic scan appearances were those of gross calcific chronic pancreatitis. Despite active bleeding, it was not possible to demonstrate its source at angiography, thus precluding therapeutic embolization. Thirty six hours after commencing an infusion of somatostatin, repeat endoscopy showed no evidence of active or recent bleeding. The infusion was continued for 5 days during which time he had no further bleeding.
Gentamicin-resistant enterococci and endocarditis
Authors: Holliman R , Smyth E 
Published: December 2008

Summary
We report a case of endocarditis associated with a highly gentamicin-resistant enterococcus that failed to respond to conventional antibiotic combination therapy. Clinical resolution was achieved following cardiac surgery and antimicrobial treatment dictated by in vitro testing of the patient’s organism. Laboratories should test blood culture isolates of enterococci for high level gentamicin resistance. Management of such cases requires individual assessment and extensive laboratory investigation.
Massive prolactinoma with galactorrhoea in a prepubertal boy
Authors: Ross R J M , McEniery J M , Grossman A , Doniach I , Besser G M , Savage M O 
Published: December 2008

Summary
An 8 year old prepubertal boy presented with raised intracranial pressure, left proptosis and was noted to have galactorrhoea. Cranial computerized tomography revealed a large pituitary tumour infiltrating the cavernous sinus and left orbit. The serum prolactin was 180,600 mU/l (normal value less than 360 mU/l). Prolactinomas are rare in children and galactorrhoea has not previously been reported in a prepubertal child. The management of massive prolactinomas is difficult, but the child presented has made an impressive response to a combination of treatment with surgery, dopamine agonist therapy and radiotherapy.
Systemic Weber-Christian disease with reversible bilateral ureteric obstruction
Authors: Brawn L A , Ramsay L E , Shortland J R , Williams J L 
Published: December 2008

Summary
It has been proposed that idiopathic retroperitoneal fibrosis may be a consequence of ‘healed’ retroperitoneal lesions of systemic Weber-Christian disease. However ureteric obstruction which is the hallmark of idiopathic retroperitoneal fibrosis, has not been described in systemic Weber-Christian disease. We report a patient with systemic Weber-Christian disease who, during a relapse, developed bilateral ureteric obstruction which resolved when the Weber-Christian disease remitted. The radiological appearances were consistent with a diagnosis of idiopathic retroperitoneal fibrosis, but the clinical course was slightly atypical in that the ureteric obstruction resolved completely and rapidly. Ureteric obstruction can complicate systemic Weber-Christian disease and this observation gives support to the hypothesis that idiopathic retroperitoneal fibrosis is related to systemic Weber-Christian disease.
Acute presentation of cystic fibrosis in an adult
Authors: Gardiner K R , Cranley B 
Published: December 2008

Summary
The case history of a female patient presenting at the age of 25 with cystic fibrosis is described. Despite longstanding significant respiratory symptoms, she did not attend hospital until she was 23 and then failed to appear for further investigations and treatment.
At the age of 25, she was admitted with a severe lower respiratory tract infection and respiratory failure. Within 5 days, acute intestinal obstruction developed which was unresponsive to conservative therapy. At laparotomy the small bowel was obstructed just proximally to the ileocaecal valve by solid faecal material. Post-operatively, the diagnosis of cystic fibrosis was confirmed by quantitative pilocarpine iontophoresis tests.
The literature is reviewed regarding the adult presentations of cystic fibrosis and the recommended treatment for distal intestinal obstruction syndrome. The presence of adult cystic patients within the community is emphasized.