bluuebunny/crossref_metadata_2025_split huggingface dataset:
Non-steroidal anti-inflammatory drug ingestion: retrospective study of 272 bleeding or perforated peptic ulcers
Authors: Smedley F H , Taube M , Leach R , Wastell C 
Published: December 2008

Summary
The ingestion of non-steroidal anti-inflammatory drugs (NSAID) in 272 patients with bleeding or perforated peptic ulcer was compared with 272 age/sex matched controls. A significantly higher proportion of patients with gastric ulcers had received NSAID than those with duodenal ulcers.
Twelve of 90 (13%) patients admitted with bleeding duodenal ulcers had received NSAID compared with 11 of 26 (42%) patients with bleeding gastric ulcers (P = 0.003). Sixteen of 132 (12%) patients with perforated duodenal ulcer were taking NSAID compared with 8 of 24 (33%) patients with perforated gastric ulcer. Thirty eight percent of patients with both bleeding and perforated gastric ulcers had received NSAID compared with 13% bleeding and perforated duodenal ulcers (P less than 0.002).
This study confirms the association of NSAID and complicated peptic ulcer in patients of over 65 years and highlights the particular susceptibility of the gastric mucosa to their injurious effect.
Life-threatening acute hyponatraemia induced by low dose cyclophosphamide and indomethacin
Authors: Webberley M J , Murray J A 
Published: December 2008

Summary
We report the case of a patient with multiple myeloma who developed acute life-threatening water intoxication following treatment with oral indomethacin and low dose intravenous cyclophosphamide. We describe a possible drug interaction between these two drugs and recommend that they should only be used together with caution.
Pyloric obstruction due to gastric tuberculosis—an endoscopic diagnosis
Authors: Gupta B , Mathew S , Bhalla S 
Published: December 2008

Summary
A 22 year old male presented with symptoms of gastric outlet obstruction. Endoscopy showed a hypertrophic nodular lesion around the pyloric opening with pyloric stenosis. The endoscopic biopsy and histopathological examination revealed tuberculosis involving the stomach, an extremely rare lesion.
Transtelephonic electrocardiographic monitoring for detection and treatment of cardiac arrhythmia
Authors: Safe A F , Maxwell R T 
Published: December 2008

Summary
Published data on the use of transtelephonic electrocardiographic monitoring for evaluation of episodic symptoms suggestive of cardiac arrhythmia are sparse and conflicting. We have reviewed the use of one such device ‘Cardiomemo’ on our unit over an 18 month period. The study showed that transtelephonic electrocardiographic monitoring is useful in documentation of infrequent or sporadic episodes directly related to symptoms when 24-hour ambulatory electrocardiograph monitoring is normal.
How much can elderly patients tell us about their medications?
Authors: Al Mahdy H , Seymour D G 
Published: December 2008

Summary
Two hundred and sixty one patients attending a geriatric service were asked to give details of their usual medications without reference to drug bottles or written lists. Recall was tested in 4 categories: name of drugs, drug dosage, frequency of administration, and reason for the drug being prescribed. Drug recall was poor in all 4 categories, but particularly in respect of drug naming where only 10% of patients were able to give a complete list of their drugs. Out-patients were more knowledgeable about their medications than day hospital patients or inpatients. The rate of errors and omissions was correlated with increasing age, decreasing mental score, and to a lesser extent, number of drugs prescribed. Sixty-four percent of patients administered their own medications at home, and their ability to recall their medications was superior to that of other patients. The implications of the above findings are discussed.
Hyperthyroidism during pregnancy due to coexistence of struma ovarii and Graves' disease
Authors: Kung A W C , Ma J T C , Wang C , Young R T 
Published: December 2008

Summary
A patient with hyperthyroid Graves' disease and struma ovarii is described. She had pre-existing Graves' disease and positive thyrotrophin receptor antibody. She was treated with radioactive iodine 5 months before she became pregnant. Paripartum she had torsion of an ovarian cyst with histological evidence of a functional struma ovarii. Immediate exacerbation of her thyrotoxic state was observed after operation as a result of release of thyroid hormone from the tumour. It is postulated that the tumour was stimulated by circulating thyrotrophin receptor antibody.
Thyrotoxic crisis presenting as status epilepticus
Authors: Safe A F , Griffiths K D , Maxwell R T 
Published: December 2008

Summary
A 30 year old male patient with thyrotoxic crisis presenting as status epilepticus is reported. The aetiology, manifestations and management of this medical emergency are discussed. The importance of prompt, vigorous and comprehensive treatment of thyrotoxic crisis is emphasized. Rapid control of hyperthyroidism as well as other supportive measures are essential if the high fatality rate is to be reduced. Comprehensive management reduces mortality from 90% to 20%.
Leptospirosis presenting as a flaccid paraplegia
Authors: Mumford C , Dudley N , Terry H 
Published: December 2008

Summary
A fatal case of leptospirosis in a 64 year old farm worker is described. The dramatic neurological presentation with a rapidly evolving flaccid paraplegia associated with biochemical evidence of renal and hepatic dysfunction is discussed. Attention is drawn to the wide range of neurological symptoms reported in leptospirosis, and to the possibility that this infectious disease may present neurologically.
Successful treatment with ketoconazole of Cushing's syndrome in pregnancy
Authors: Amado J A , Pesquera C , Gonzalez E M , Otero M , Freijanes J , Alvarez A 
Published: December 2008

Summary
Patients with Cushing's syndrome rarely become pregnant. This is a high risk situation both for the fetus and the mother, if untreated. We report a patient with Cushing's syndrome due to adrenocortical adenoma who became pregnant and was successfully treated with ketoconazole during the last period of pregnancy.
Premature coronary artery disease and the Prader-Willi syndrome
Authors: Page S R , Nussey S S , Haywood G A , Jenkins J S 
Published: December 2008

Summary
A 28 year old woman with the Prader-Willi syndrome developed chest pain and loss of anterior R wave amplitude on the electrocardiogram. Cardiac catheterization demonstrated a severe proximal stenosis of the left anterior descending artery with delayed antegrade flow together with antero-apical akinesia consistent with myocardial infarction. Physicians involved in the management of patients with the Prader-Willi syndrome should be aware of this association with premature coronary artery disease.
Myoglobinuria: the importance of reaching a firm diagnosis—a patient with defective fatty acid oxidation
Authors: Ellis C J , Dewhurst A G , Cooper M , Brenton D P , Dathan J R 
Published: December 2008

Summary
A 52 year old man presented with myoglobinuria-induced acute renal failure requiring dialysis. Despite renal biopsy, the cause of the myoglobinuria was not established until he re-presented a year later with a milder episode. At this stage investigations, including a muscle biopsy, demonstrated a defect in fatty acid oxidation amenable to dietary and lifestyle advice. This report emphasizes the importance of reaching a definitive diagnosis in myoglobinuria.
Lovastatin-induced acute rhabdomyolysis
Authors: Kogan A D , Orenstein S 
Published: December 2008

Summary
Severe rhabdomyolysis complicated by respiratory and renal failure developed three weeks after initiation of low dose lovastatin therapy in a 79 year old, non-immunocompromised patient. The concomitant use of gemfibrozil may increase the risk of this complication.
Rifampicin-induced upper gastrointestinal bleeding
Authors: Zargar S A , Thapa B R , Sahni A , Mehta S 
Published: December 2008

Summary
Gastrointestinal disturbances like anorexia, nausea, vomiting, abdominal discomfort and diarrhoea are known adverse effects of rifampicin. We report an upper gastrointestinal bleeding due to haemorrhagic gastric erosions after ingestion of rifampicin for pulmonary tuberculosis. The cause and effect relationship between development of haemorrhagic gastric erosions and rifampicin administration was confirmed by rechallenge with rifampicin. To our knowledge no such adverse effect of rifampicin has been reported previously.
Recurrent thrombosis and anticardiolipin antibodies associated with adenocarcinoma of the lung
Authors: Shaukat M N , Hughes P 
Published: December 2008

Summary
A case of adenocarcinoma of the lung, in which high titre anticardiolipin antibodies were associated with recurrent venous thromboses resistant to all forms of therapy, is described. It is suggested that such an autoimmune response may be a contributory factor in the para-neoplastic development of vascular thromboses.
Behavioural treatment of epilepsyBased on a lecture given to the European Medical Research Group on 20 November 1989.
Authors: Fenwick P B C 
Published: December 2008

Summary
There is abundant evidence of the close interrelation between the induction and inhibition of seizure activity and the patient's thoughts, feelings and behaviour. The detailed knowledge that we now have of the epileptic focus and the way that it is connected to the surrounding cerebral mechanisms, makes it possible for many patients with focal epilepsy to establish a significant degree of seizure control by altering their thinking and behaviour.
Antiphospholipid antibodies and Mycoplasma pneumoniae infection
Authors: Snowden N , Wilson P B , Longson M , Pumphrey R S H 
Published: December 2008

Summary
Anticardiolipin antibody levels were measured in 57 patients with Mycoplasma pneumoniae infection and 21 patients with other infections. Significantly more patients in the mycoplasma group had increased IgM and IgG anticardiolipin. Within the mycoplasma group significantly higher titres were found in patients with severe infection (assessed by need for hospital admission) and in patients with cold agglutinins. A tendency for particularly high titres to occur in patients with extra-pulmonary complications was identified.
The relationship between ‘normal’ fluid retention in women and idiopathic oedema
Authors: Denning D W , Dunnigan M G , Tillman J , Davis J A , Forrest C A 
Published: December 2008

Summary
A sample of women attending a gynaecological outpatient clinic were examined for symptoms and objective signs of fluid retention. Patients completed a questionnaire on symptoms suggesting fluid retention and recorded daily weight and abdominal girth variation. Daily weight variation varied from 0–9 pounds (mode 2 pounds) with no discernable difference between premenstrual and intermenstrual variation. Daily girth variation varied from 0–6 inches (mode 1 inch). Symptoms of breast swelling were more common premenstrually, finger/hand and ankle swelling intermenstrually and abdominal swelling occurred with equal frequency in both periods. No correlation between symptoms and weight variation was seen although abdominal swelling and girth variation were associated (P &lt; 0.04).
The results indicate that symptoms of mild fluid retention and of diurnal weight and abdominal girth variation are part of the everyday experience of our study population. There is no clear-cut separation between ‘normal’ and ‘abnormal’ fluid retention (idiopathic oedema, periodic oedema, fluid retention syndrome); the latter may be an exaggeration of normal fluid-retaining mechanisms common to most women or may represent a pathological state. An approach which evaluates individual risk factors and the severity of fluid retention in each patient is recommended.
Type I protein S deficiency and skin necrosis
Authors: Craig A , Taberner D A , Fisher A H , Foster D N , Mitra J 
Published: December 2008

Summary
A kindred with Type I protein S deficiency is described in which the index case developed skin necrosis during induction of oral anticoagulant therapy for deep venous thrombosis. Two other family members with protein S deficiency have been detected, and demonstrate the clinical variability of this condition.
A clinical audit of thallium – technetium subtraction parathyroid scans
Authors: Samanta A , Wilson B , Iqbal J , Burden A C , Walls J , Cosgriff P 
Published: December 2008

Summary
Eighty six consecutive thallium-technetium subtraction parathyroid scans performed over a three year period for hypercalcaemia have been evaluated. Twelve had chronic renal failure, 11 had hypercalcaemia due to non-hyperparathyroid causes and in 10 the imaging study was technically inadequate. The remaining 53 technically adequate studies performed for hypercalcaemia clinically thought to be possibly due to hyperparathyroidism have been analysed. Of 20 (38%) positive scans, 13 came to surgery (10 correctly localized parathyroid adenomas, 2 with multiple gland hyperplasia, and 1 papillary carcinoma of the thyroid). Of 33 (62%) negative scans, 9 had surgical exploration on the basis of strong clinical grounds and all had parathyroid adenomas.
Multiple biochemical parameters have been assessed in relation to a positive outcome on scan. The adjusted calcium-phosphate product and the ratio of the adjusted calcium-phosphate product to creatinine (Ca × P/Cr) were both significantly lower in the scan positive group (P &lt; 0.01). The scan positive group had a significantly higher mean level of PTH (P &lt; 0.001) and lower mean level of phosphate (P &lt; 0.001). The present experience shows that parathyroid imaging is useful in localizing parathyroid adenomas in 50% of cases (10 out of 19). This figure is at the lower end of the range of previously published results.
It is less effective in demonstrating multiple gland hyperplasia. The decision as to whether to undertake surgical exploration when the scan is negative has been based successfully on clinical judgement. We feel that an analysis of this nature is important, as it gives insights into the practical relevance of parathyroid imaging in the context of routine clinical work.
Acquired von Willebrand's disease and hypothyroidism: report of a case presenting with menorrhagia
Authors: Blesing N E , Hambley H , McDonald G A 
Published: December 2008

SummaryA 17 year old woman presented with severe anaemia due to menorrhagia. On investigation, she was shown to have abnormalities of her haemostatic mechanism consistent with von Willebrand's disease Type I, although there was no family history of this disorder. In addition, she was shown to have severe primary hypothyroidism. On correction of hypothyroidism with oral thyroxine, her coagulation defects returned to normal and menorrhagia ceased. This is consistent with acquired von Willebrand's disease secondary to hypothyroidism.
Multiple Salmonella enteritidis leg abscesses in a patient with systemic lupus erythematosus
Authors: Shamiss A , Thaler M , Nussinovitch N , Zissin R , Rosenthal T 
Published: December 2008

Summary
We describe a 19 year old woman with systemic lupus erythematosus on corticosteroid therapy, who developed bilateral, multiple, gas-forming Salmonella enteritidis leg abscesses and osteomyelitis mimicking deep vein thrombosis. The infection was treated successfully by a combination of surgical drainage and intravenous ceftriaxone, followed by prolonged oral pefloxacin.
This rare case of gas-producing S. enteritidis emphasizes the difficulty in diagnosing such complications in active systemic lupus erythematosus.
Acanthosis nigricans in obese women with the polycystic ovary syndrome: disease spectrum not distinct entity
Authors: Conway G S , Jacobs H S 
Published: December 2008

Summary
Fasting and stimulated insulin concentrations in four patients with acanthosis nigricans and polycystic ovary syndrome were compared with four patients, matched for weight and ovarian morphology, without acanthosis. The median fasting serum insulin concentrations were 114.2 and 25.1 mU/l in the respective groups (P = 0.02). One additional patient was investigated before and after an 18% increase in weight which resulted in a 170% increase in fasting insulin concentrations and the development of acanthosis nigricans. These observations suggest that there is variation between individuals in the degree of obesity that results in the development of acanthosis and that obese patients with this skin condition represent the severe end of the spectrum of the polycystic ovary syndrome.
Analgesic nitrous oxide for alcohol withdrawal: a critical appraisal after 10 years' use
Authors: Gillman M A , Lichtigfeld F J 
Published: December 2008

Summary
We describe a method of treating the mild to moderate alcohol withdrawal state which has been used successfully for 10 years in over 7,000 cases. It is now the standard therapy at the largest dedicated alcoholic rehabilitation centre in Southern Africa. The technique uses analgesic (subanaesthetic) concentrations of nitrous oxide, which in most cases is administered on a single occasion for 20 minutes only. This results in the most rapid detoxification presently available, such that within an hour of the commencement of therapy the patient is so improved that they can eat the next ward meal. Provided the correct equipment and simple training is used this non-anaesthetic treatment is completely free of any serious side effects and the patient is at all times conscious and cooperative. Apart from this the amounts of sedative medication, such as benzodiazepines, are drastically reduced during detoxification. Because of the rapidity of the therapeutic response this technique is useful also as a screening test for assessing those patients requiring intensive therapy for the alcohol withdrawal state. There is evidence of the usefulness of analgesic nitrous oxide therapy for treating other addictive withdrawal states including opioid and nicotine.
Retinal periphlebitis in ulcerative colitis
Authors: Kelly I M G , Frith P A , Hyman N M , Jewell D P 
Published: December 2008

Summary
A man presented with unilateral visual blurring associated with bilateral retinal periphlebitis which was felt to be a complication of his biopsy-proven active ulcerative colitis. Retinal periphlebitis has been associated rarely with some forms of colitis but we can find no report of its occurrence in association with ulcerative colitis although other ocular inflammatory disorders are well recognized.
Medical training in the European Community
Authors: Crisp A H 
Published: December 2008

Summary
The free movement of doctors within the European Community demands harmonization of standards of medical practice and carries major implications of an undergraduate and postgraduate educational kind. These have begun to be addressed by the first three Medical Directives and also by a series of reports produced by the Advisory Committee on Medical Training to the European Community. This Committee was established in 1975 in order to provide informed agreed advice to the Commission. Many tasks remain to be tackled. A system of mutual inspection of the examination processes and standards in Member States should be established. Control must be exercised over the numbers of doctors produced since educational resources, including numbers of patients available for study, are limited. Thus, excellent standards of medical practice can only be developed and maintained if the primacy of clinical skills derived from the study of patients is recognized as essential in this respect. In some Member States at the present time there are many unemployed and therefore presumably deskilled doctors.
Haemorrhagic pancreatitis—a cause of death in severe potassium permanganate poisoning
Authors: Middleton S J , Jacyna M , McClaren D , Robinson R , Thomas H C 
Published: December 2008

Summary
Severe potassium permanganate poisoning (more than 10 g of potassium permanganate) is invariably associated with massive systemic upset and death. Multiple organ damage has been recognized as an inevitable consequence of such an overdose, although pancreatitis has not been previously reported. Death due to cardiovascular collapse and profound hypotension is a common end point in those who reach hospital, but the pathogenesis is uncertain. We report a case of haemorrhagic pancreatitis following an overdose of potassium permanganate and suggest that this complication may be an unrecognized factor contributing to the extremely high mortality rate associated with this condition.
Body packing—a case report and review of the literature
Authors: Stewart A , Heaton N D , Hogbin B 
Published: December 2008

SummaryDrug smuggling by internal bodily concealment is a growing international problem. The management of a patient who swallowed packages containing heroin is described. The medical management, indications for surgery and the ethical dilemmas of treating patients with drugs concealed within the gastrointestinal tract are discussed.
Is serum gamma-glutamyl transferase a good marker of alcohol intake in stroke patients?
Authors: Peck K , Shinton R , Beevers G 
Published: December 2008

Summary
Serial serum gamma-glutamyl transferase (GGT) levels were estimated in 23 consecutive patients admitted to hospital with a diagnosis of acute stroke. The proportion of patients with elevated GGT levels in the initial, 36-hour and 72-hour samples was 13%, 30% and 24% respectively, suggesting a transient rise following a stroke. Patients with a history of diabetes mellitus had an initial serum GGT level 21 IU/l (95% confidence interval 6 to 37) higher than non-diabetics.
We conclude that GGT levels after a stroke may reflect a history of diabetes and cerebral damage as well as the usual more established causes. Physicians, therefore, should be wary of attributing all unexplained high GGT levels in stroke patients to alcohol.
Reactivation of latent melioidosis
Authors: Johnson A B , Ali N 
Published: December 2008

Summary
Reports of melioidosis in residents of European countries are rare. We describe a case of reactivation of latent melioidosis in a United Kingdom resident. The case demonstrates the lack of clinical response to chemotherapy despite proven in vitro sensitivity of the organism to the drugs used. It is important to consider melioidosis as a cause of septicaemic illness in patients who have travelled to, or been resident in South-East Asia.
Spreading sepsis by cystoscopy
Authors: Bavetta S , Olsha O , Fenely J 
Published: December 2008

Summary
A healthy 54 year old man was investigated for haematuria. In spite of a proven urinary tract infection a cystoscopy was carried out with no antibiotic therapy. As a result he developed systemic infection leading to two independent, and potentially fatal, complications: vertebral osteomyelitis and a mycotic false aneurysm.
Carotid artery stenoses and thrombosis secondary to cavernous sinus thromboses in Fusobacterium necrophorum meningitis
Authors: Jones T H , Bergvall V , Bradshaw J P P 
Published: December 2008

Summary
We report the case of a young man with Fusobacterium necrophorum meningitis who developed bilateral carotid artery stenosis associated with thrombosis of the cavernous sinuses. Intraluminal clot was present in the region of the stenoses for which he was anticoagulated. The clinical presentation, problems with diagnosis, the use of anticoagulation and the need for prolonged treatment with metronidazole are discussed.