bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ectopic Cushing’s syndrome with periodic hormonogenesis--a case suggesting a pathogenetic mechanism
Authors: Estopiñán V , Varela C , Riobo P , Dominguez J R , Sancho J 
Published: December 2008

Summary
We report on a case of ectopic Cushing’s syndrome due to a thymic carcinoid tumour with periodic hormonogenesis. Periods of hormonal production averaged 27 days. Prior to bilateral adrenalectomy, mean (s.d) values of ACTH and cortisol were 202.1 (50.3) pg/ml and 46 (14.7) micrograms/dl, ACTH rising to 3996 +/- 425 pg/ml (P less than 0.01) and cortisol falling to 6.3 +/- 1.5 micrograms/dl (P less than 0.01) in the immediate postoperative period. During the late postoperative period (2-13 months following surgery) ACTH levels fell to 509.3 (123.8) pg/ml (P less than 0.01), but remaining even higher (P less than 0.01) than before adrenalectomy. The pattern of ACTH in the present case suggests the existence of a negative feedback exerted by the cortisol over tumoral ACTH.
Clostridium difficile, sulphasalazine, and ulcerative colitis
Authors: Burke D A , Axon A T R 
Published: December 2008

Summary
Clostridium difficile has been implicated in the relapse of ulcerative colitis. Controversy exists over this role and its relationship to sulphasalazine exposure. Sixty two of 77 patients with a documented relapse of ulcerative colitis were investigated for the presence of Clostridium difficile, or its toxin, prior to hospitalization. There was a low incidence of detection which was related to antibiotic exposure (2/62). Sampling during the treatment period showed that the occurrence of Clostridium difficile in the stool was related to antibiotic treatment (2/66). Fifty six percent of patients were taking sulphasalazine, none of whom became culture or toxin positive. This study demonstrates that Clostridium difficile is not related to relapse of ulcerative colitis and is not secondarily acquired during relapse unless the patient is exposed to antibiotics. Sulphasalazine does not predispose to acquisition of Clostridium difficile. There is no role for routine screening or treatment of Clostridium difficile in ulcerative colitis.
Comparison of flupirtine and indomethacin on frusemide-induced diuresis
Authors: Johnston A , Warrington S J , Turner P , Riethmuller-Winzen H 
Published: December 2008

Summary
A single oral dose of flupirtine maleate, a novel analgesic agent, did not antagonize significantly the diuretic action of frusemide when compared with indomethacin and placebo in normal human volunteers.
Hypernatraemia due to a reset osmostat for vasopressin release and thirst, complicated by nephrogenic diabetes insipidus
Authors: Thompson C J , Freeman J , Record C O , Baylis P H 
Published: December 2008

Summary
We describe a patient with chronic hypernatraemia (plasma sodium 148-155 mmol/l) and partial nephrogenic diabetes insipidus who had received prolonged lithium treatment. Despite stopping the drug for one year the abnormalities remained. Infusion of hypertonic saline (NaCl 855 mmol/l) allowed the characterization of osmoregulation of thirst and vasopressin secretion. Linear regression analysis of plasma vasopressin and osmolality defined the function, pAVP = 0.27 (pOsm - 301), and analysis of thirst measured by a visual analogue scale and plasma osmolality, the function, thirst = 0.16 (pOsm - 302) where pAVP and pOsm represent plasma arginine vasopressin and osmolality respectively. The slopes of the regression lines which describe the sensitivity of the osmoreceptors were within the normal range, but both abscissal intercepts, which define the thresholds for vasopressin release and thirst, were markedly elevated in comparison to normal (upper limit less than 290 mOsm/kg). Other investigations of electrolytes, anterior pituitary function and high definition computed tomographic scanning of hypothalamo-pituitary region were all normal.
We conclude that this patient’s chronic hypernatraemia was due to resetting of the osmostats for both vasopressin release and thirst, a rarely described mechanism to account for hypernatraemia. Although it is probable that the partial nephrogenic diabetes insipidus was related to prolonged lithium therapy, the cause of the reset osmostats remains unclear.
Acute mastitis; a novel presentation of relapsing polychondritis
Authors: Haigh R , Scott-Coombes D , Seckl J R 
Published: December 2008

SummaryA 30 year old female with previous Crohn’s disease presented with recurrent cutaneous vasculitis and polyarthritis. She subsequently developed recurrent transient bilateral mastitis with auricular and laryngotracheal chondritis typical of relapsing polychondritis. Acute mastitis is a previously unrecognized association of this disorder.
Renal replacement therapy in patients aged over 60 years
Authors: Tapson J S , Rodger R S C , Mansy H , Elliott R W , Ward M K , Wilkinson R 
Published: December 2008

Summary
The availability of dialysis for patients with end-stage renal failure in the United Kingdom has lagged behind that in most of the rest of Europe and USA, although there has been considerable improvement over recent years. Concern about prognosis and quality of life on renal replacement therapy, together with shortage of facilities has meant that some elderly people have been denied treatment. A retrospective study of all patients commencing renal replacement therapy in Newcastle between 1974 and 1985 was performed. The five year survival of patients aged more than 60 years at the start of treatment (n = 122) was 53%, compared with 68% for a cohort of individuals aged less than 60 years (n = 632). A questionnaire sent to the 62 elderly patients surviving at the end of the follow-up period revealed that most were married, independent, active and lived in their own home. They were not lonely, generally enjoyed life and were happy with their mode of renal replacement therapy. These results show that elderly patients make good dialysis candidates and they should not be denied treatment on the basis of age alone. Greater funding of renal services is necessary to accommodate these patients.
The treatment of Guillain-Barré syndrome by modified plasma exchange--a cost effective method for developing countries
Authors: De Silva H J , Gamage R , Herath H K N , Karunanayake M G S , Peiris J B 
Published: December 2008

Summary
Six patients with the Guillain-Barré syndrome were treated by modified plasma exchange. Five of them showed a rapid improvement which was not consistent with the natural history of the disease. The improvement was assessed by monitoring vital capacity and muscle power, grading the ability to perform motor functions and by the duration of the hospital stay. The method of plasma exchange we used was simpler and cheaper than the conventional method. We recommend the use of our method, especially in developing countries with financial constraints and poor facilities.
Isolated angiitis of the brain in a young female on the contraceptive pill
Authors: Nagaratnam N , James W E 
Published: December 2008

Summary
The case of a 15 year old girl with a rapidly progressing right sided hemiparesis is reported. The history and clinical manifestations were suggestive of either herpes simplex encephalitis or occlusion of the left middle cerebral artery. At necropsy an occlusive thrombosis of the left middle cerebral artery due to a segmental necrotizing granulomatous panarteritis was found. The cause was obscure. A plausible incriminating factor was the contraceptive pill.
Japanese encephalitis--an important cause of acute childhood encephalopathy in Lucknow, India.
Authors: Kumar R , Mathur A , Kumar A , Sharma S , Saksena P N , Chaturvedi U C 
Published: December 2008

Summary
Eighty-six randomly selected children between 6 months and 12 years of age admitted with acute unexplained encephalopathy over a one year period were examined for evidence of Japanese encephalitis. One or more indicators of the infection were present in 36 (41.8%). Viral isolation from brain tissue was possible in 2 of 12 patients and from cerebrospinal fluid in 19 out of 62 patients. Serological evidence of probable Japanese encephalitis was found in 21 out of 36 patients. Japanese encephalitis is an important cause of acute childhood encephalopathy in the Lucknow area, where it is probably endemic.
Hypocalcaemia in autoimmune haemolytic anaemia and pernicious anaemia
Authors: Baba A A , Maharaj D 
Published: December 2008

Summary
A 71 year old woman presented with hypocalcaemia in association with autoimmune haemolytic anaemia and pernicious anaemia. The hypocalcaemia resolved only when the haemolytic anaemia and pernicious anaemia were successfully treated. The possible pathogenic mechanisms are discussed.
Early onset high grade dysplasia in ulcerative colitis
Authors: Clements D , Suarez V , Thompson H , Alexander-Williams J , Allan R N 
Published: December 2008

Summary
We report a patient with ulcerative colitis who underwent colectomy when aged 25 years for multifocal high grade dysplasia which had developed within 2 years of diagnosis, and only 5 1/2 years after his first symptoms. The implications of this case for the management of ulcerative colitis are discussed.
Mesenteric fibromatosis with ureteric stenosis.
Authors: Hailemariam S , Jaeger P , Goebel N , Grant J W 
Published: December 2008

Summary
We report a case of a 37 year old man who presented with vomiting and colicky abdominal pain and who was found to have microscopic haematuria. Radiological-examination showed a right hydronephrosis apparently caused by a paracaecal tumour extending to involve the right ureter. This was resected and proved histologically to be a mesenteric fibromatosis. The patient has none of the factors predisposing to the development of this lesion, in particular Gardner’s syndrome. Eight months following surgery he appears to have made a full recovery. Previous publications on this rare intra-abdominal neoplasm are reviewed.
Unusual presentation of culture positive brucellosis
Authors: Jayakumar R V , Al-Aska A K , Subesinghe N , Wright S G 
Published: December 2008

Summary
We have reviewed the clinical presentation of 100 consecutive culture positive cases of brucellosis which came under our care during the last two years. Of these, six had atypical presentations and but for the routine practice of sending blood for brucella culture, the diagnosis would have been missed. The unusual presentations included a 19 year old boy presenting as an acute abdomen ending in laparotomy, a 52 year old man presenting with a psoas abscess, a 29 year old woman presenting with a transient perinephric mass, a 75 year old man with an acute flare up of his osteoarthritis, a 65 year old diabetic man presenting in an insulin-resistant diabetic state and a 35 year old man presenting with a cauda equina syndrome.
Transient global amnesia and left frontal haemorrhage
Authors: Jacome Daniel E , Yanez Gonzalo F 
Published: December 2008

Summary
A patient developed spontaneous, acute, dominant frontal lobe haemorrhage neighbouring on a zone of pre-existing post-traumatic encephalomalacia manifesting clinically as transient global amnesia. Amnesia can be secondary to disease of the frontal lobe, affecting pathways interconnecting the basal forebrain and hippocampus of the temporal lobe.
Effects of captopril in patients with chronic obstructive pulmonary disease and secondary pulmonary hypertension
Authors: Patakas D , Georgopoulos D , Rodini H , Christaki P 
Published: December 2008

Summary
Ten patients with chronic obstructive pulmonary disease (COPD) with normal left ventricular function were given a single dose of captopril (0.25 mg/kg). Mean systemic arterial pressure, heart rate and coronary flow to the right ventricle were reduced significantly after captopril. In contrast captopril did not cause a significant fall in pulmonary arterial pressure or pulmonary vascular resistance. We conclude that captopril fails to produce haemodynamic benefits in such hypoxic patients and that angiotensin II is not playing a significant role in maintaining pulmonary vasoconstriction.
Survival of twenty-two months in a patient with primary plasma cell leukaemia treated with melphalan and prednisolone
Authors: Walker J D , Kaczmarski R S 
Published: December 2008

Summary
In the majority of cases plasma cell leukaemia is a rapidly fatal disease with a mean survival time of five months. There have been reports of increased survival using various regimens of chemotherapy although most cases eventually relapse. We describe a patient with primary plasma cell leukaemia who responded to a combination of oral melphalan and prednisolone with control of the disease in the bone marrow but relapsed with extramedullary disease in the central nervous system and testes, and died 22 months after diagnosis. Melphalan poorly penetrates the central nervous system and its testicular penetration is unknown.
Erythema induratum (of Bazin) in a patient with endometrial tuberculosis
Authors: De Silva H J , Goonetilleke A K E , De Silva N R , Amarasekera L R , Jayawickrama U S 
Published: December 2008

Summary
We report erythema induratum in a patient who was found to have active endometrial tuberculosis. This case report emphasizes the importance of an exhaustive search for active tuberculosis in patients with erythema induratum, especially in countries where tuberculosis is prevalent, as the indiscriminate treatment of erythema induratum with steroids may be harmful.
Trends in splenectomy in the Trent region 1972-85
Authors: Fellows I W , Hart S , Toghill P J 
Published: December 2008

SummaryDuring the period 1972-85, 3712 splenectomies were performed in the Trent region giving a mean splenectomy rate of 5.8 per 100,000 population per year. Of these, 37.4% were incidental to other surgical operations and 23.4% were as a result of trauma. During this period there was a marked reduction in the splenectomy rate in children aged under 10 years for trauma and for haematological diseases. No such reduction was observed in older patients for these indications. Splenectomy for lymphoma fell progressively after 1977.
Improving laboratory usage: a review
Authors: Young D W 
Published: December 2008

Summary
Influencing the ordering of laboratory investigations, and in particular reducing unnecessary ones, is a vital concern to many hospitals. An account of the reasons why control is necessary is presented. The different methods evaluated are reviewed, including rationing, form design, resource management (budget control), education, protocols and decision support systems, incentives, feedback and case note appraisal. Methods of controlling the requesting of investigations are likely to be ineffective unless they take place in the correct environment. Elements of this include correct attitude and commitment by senior staff, a long term strategy, and different approaches for different groups of doctors.
The use of digoxin in 55 residential homes for elderly people
Authors: Weedle P B , Poston J W , Parish P A 
Published: December 2008

Summary
Data relating to the use of digoxin from a descriptive epidemiological study of drug use in residential homes for elderly people were analysed. Of the 1,888 residents in the study homes, 212 were receiving cardiac glycosides. The ratio of females to males who received cardiac glycosides was 2.8:1; however, this was not statistically significant as it reflected the overall population. The median age of recipients of cardiac glycosides was 85.2 years and they were significantly older than non-recipients (P less than 0.001). The cardiac glycosides were almost exclusively prescribed as digoxin, the median dose was 125 micrograms with a range of 62.5 to 250 micrograms, and the median duration of treatment was 2.3 years, range less than 0.1 to 10.1 years. Digoxin was involved in a total of 152 potential drug interactions, 12 of which were potentially highly significant clinically.
Angiotropic large cell lymphoma (angioendotheliomatosis) presenting with protein-losing enteropathy
Authors: Al-Izzi M S , Sidhu P S , Garside P J , Menai-Williams R 
Published: December 2008

Summary
A 73 year old female presented with progressive hypoproteinaemic oedema which was resistant to treatment. The cause was not established until post-mortem, when it was found that she had angiotropic large cell lymphoma involving the vessels of the large intestine with mucosal ulceration. To our knowledge, this is the first report of angiotropic large cell lymphoma, which usually presents with neurological and skin involvement, presenting with protein-losing enteropathy.
Idiopathic spontaneous haemoperitoneum
Authors: Sanderson P L , Davies M F P , Howat J M T 
Published: December 2008

Summary
A case is described of bleeding arising from the falciform ligament which occurred in the absence of obvious local pathology. Spontaneous bleeding from this site hitherto has not been reported. Previously described cases of idiopathic spontaneous haemoperitoneum and factors implicated in the aetiology of this rare condition are reviewed.
Plasma lipids can be reliably assessed within 24 hours after acute myocardial infarction
Authors: Sewdarsen M , Vythilingum S , Jialal I , Nadar R 
Published: December 2008

Summary
Total serum cholesterol and triglycerides were measured in 159 Indian patients (134 males) with acute myocardial infarction during their stay in hospital (days 1 and 2) and 3 months later in order to assess whether lipid levels measured soon after acute myocardial infarction represent basal values. Early and 3 month lipid levels were also compared according to the sex and glucose tolerance of the patients.
The mean total cholesterol levels on admission (day 1) were comparable to the 3 month values in both men (6.09 +/- 0.10 vs 6.18 +/- 0.09 mmol/l) and women (6.75 +/- 0.30 vs 6.44 +/- 0.22 mmol/l) irrespective of glucose tolerance. In the entire group cholesterol levels on day 2 were significantly lower than the admission and 3 month values. Nevertheless there was a significant correlation between day 2 and 3 month values (P less than 0.0005).
Serum triglyceride levels on day 2 were influenced by glucose tolerance and were significantly lower than the 3 month values in patients with normal glucose tolerance but not in patients with abnormal glucose tolerance. However there with a significant correlation between day 2 triglyceride values in patients with both normal and abnormal glucose tolerance. These results suggest that serum cholesterol measured on admission after acute myocardial infarction may be reliably used to represent basal values in both men and women irrespective of glucose tolerance. Although cholesterol and triglycerides measured on day 2 vary with either the gender or glucose tolerance of the patients, these values are still a useful guide to the patients’ basal lipid state.
Frank rectal bleeding: a prospective study of causes in patients over the age of 40
Authors: Cheung P S Y , Wong S K C , Boey J , Lai C K 
Published: December 2008

Summary
In order to determine the frequency of tumours in patients presenting with frank rectal bleeding, a prospective study was carried out in 337 patients over the age of 40 attending our Proctology Clinic. After making a clinical diagnosis, flexible sigmoidoscopy followed by barium enema was performed. Excluding 7 digitally palpable rectal cancers, there were 30 cancers (9.1%), 34 polyps (10.3%), 7 proctocolitis (2.1%) and 25 diverticula (7.6%) detected, giving a total diagnostic yield of 29.1%. A clinical diagnosis of bleeding sources other than haemorrhoids was made in 80% of the cancers. Flexible sigmoidoscopy detected 93.3% of the cancers and 88.2% of the polyps. Barium enema diagnosed the remaining cancers and polyps but there was a false-positive rate of 3.8%. From our results, we conclude that patients with frank rectal bleeding should be screened routinely for left-colon cancer irrespective of the clinical diagnosis. The flexible sigmoidoscope is a quick and useful tool. However, barium enema should be recommended to individuals with strong clinical suspicion of rectal bleeding other than haemorrhoids.
Fatal Stevens-Johnson syndrome following urography with iopamidol in systemic lupus erythematosus
Authors: Savill J S , Barrie R , Ghosh S , Muhlemann M , Dawson P , Pusey C D 
Published: December 2008

Summary
A 46 year old white woman with active systemic lupus erythematosus developed a skin rash 8 hours after intravenous urography with the non-ionic contrast medium iopamidol. Severe Stevens-Johnson syndrome with erythema multiforme, intrahepatic cholestasis, pulmonary infiltrates and acute renal failure ensued, leading to her death. Although non-ionic contrast media are generally less toxic than traditional ionic agents, their use in patients with immunological disease may be hazardous.
Giant hamartoma of liver mimicking malignancy
Authors: Narasimharao K L , Narasimhan K L , Katariya S , Suri S , Kaushik S , Mitra S K 
Published: December 2008

Summary
Two infants with mesenchymal hamartoma of the liver are reported. This lesion clinically simulates a malignant neoplasm very closely and awareness is essential to avoid unnecessary major hepatic resections. The cases were successfully treated with simple enucleation.
The relationship between age and duration of asthma and the presence of persistent obstruction in asthma
Authors: Connolly C K , Chan N S , Prescott R J 
Published: December 2008

Summary
Persistent obstruction was assessed in 630 asthmatic subjects by measurement after bronchodilator of the maximum potential peak flow rate and forced vital capacity. Persistent obstruction was directly related to duration of asthma. The fit was slightly better after logarithmic transformation, suggesting that the early stages of asthma may be as important as the later ones in the development of persistent obstruction. On multivariate analysis age was an additional factor in males, but made no significant difference to females. Atopy did not prove relevant. Measurements of peak flow suggested a more rapid deterioration in males of social classes III, IV and V than classes I and II. Although current smokers had lower peak flow rate and vital capacity than non-smokers, there was no evidence of a steeper decline in smokers than non-smokers suggesting that the effect of cigarette smoking was at most additive to that of duration of asthma.
Giant duodenal ulcer: the hepatic intra-arterial chemotherapy variant
Authors: Goldin E , Peretz T , Libson E 
Published: December 2008

Summary
Giant duodenal ulcers are extensive ulcers, more than 2.5 cm in diameter, that involve a large portion of the duodenal bulb. These atypical duodenal ulcers create serious problems to the patient and the physician, are frequently complicated by bleeding and penetration, and have a high mortality rate. Most of the reported cases were classified as a severe variant of the common peptic ulcer disease, others were associated with the Zollinger Ellison syndrome. We report here four patients with giant duodenal ulcers but with a different and definitive aetiology: hepatic intra-arterial chemotherapy infusion for liver metastase or primary hepatocellular carcinoma.
Occupational asthma
Authors: Newman Taylor A J 
Published: December 2008

Summary
Occupational asthma is important both as a potentially curable and preventable cause of asthma and as a model of adult onset asthma. It is induced by sensitization to a specific agent inhaled at work; for many of its causes, including inhaled proteins and the low molecular weight chemicals acid anhydrides and reactive dyes, it is probably IgE dependent. The risk of developing specific IgE and associated asthma is markedly increased in cigarette smokers, probably as a consequence of non-specific damage to the respiratory mucosa. Asthma caused by several agents, which include some of its most frequent causes, isocyanates, colophony and plicatic acid (Western Red Cedar) persists in some 50% of cases for years, and possibly indefinitely, after avoidance of exposure. The development of chronic symptomatic asthma seems particularly to occur in those with longer duration of symptomatic exposure.