bluuebunny/crossref_metadata_2025_split huggingface dataset:
Central cretinism in four successive siblings
Authors: Isichei U P , Das S C , Egbuta J O 
Published: December 2008

Summary
A study of four successive siblings, age 9, 12, 14 and 16 years with cretinism associated with congenitial central hypothyroidism (central cretinism), born to a mother in the endemic goitre region of the Jos Plateau, Nigeria, is presented. Biochemically, the defects were characterized by abnormally low basal thyroxine, triiodothyronine and thyroid stimulating hormone, as well as refractory TSH response to thyrotrophin releasing hormone and gross hyperlipidaemia. Clinically, the intellectual, physical and neurological impairment varied from moderate in the youngest to very severe in the oldest. Contrasting clinical pictures of cretinism, which appeared related to age and previous treatment were found with a spectrum ranging from predominantly myxoedematous in the youngest to predominantly neurological in the 16 year old male. Response to adequate treatment was dramatic, with restoration of severe gait disturbance occurring almost completely, but the imprints of thyroid hormone deficiency on mental defects and intellectual performance remained almost unaltered. The parents and two older sisters were normal with normal thyroid function.
Ursodeoxycholic acid therapy in chronic active hepatitis
Authors: Bateson M C 
Published: December 2008

Summary
A 41 year old woman developed chronic active hepatitis with prominent cholestasis. She was treated with prednisolone over 3 years with symptomatic benefit and improvement in serum biochemistry. However, various steroid-related side effects were encountered and steatorrhoea eventually occurred with very troublesome nocturnal diarrhoea. Therapy with ursodeoxycholic acid 750 mg daily was started. Serum alanine aminotransferase and gamma-glutamyl transferase normalized for the first time since her illness began. Steatorrhoea was abolished. There was good control of symptoms as prednisolone therapy was gradually reduced. However, when prednisolone was completely withdrawn there was a prompt biochemical deterioration. Addition of low-dose azathioprine has maintained normal blood tests over 24 months without return of the original symptoms. There are no side effects of ursodeoxycholic acid in subjects without gallstones and this agent may be effective treatment for cholestatic liver disease.
Intracavernosal metaraminol for treatment of intraoperative penile erection
Authors: Tsai S K , Hong C Y 
Published: December 2008

Summary
Four patients developed penile erection when regional anaesthesia was induced with spinal block. In another patient, penile erection developed during fentanyl-induced general anaesthesia. Injection of metaraminol into corpus cavernosum successfully achieved detumescence in all these patients. The dose of metaraminol ranged from 10 to 25 micrograms, much less than that required for the treatment of vasodilator-induced priapism. Intracavernosal injection of metaraminol is a simple, effective and safe method for immediate relief of intraoperative penile erection. It is most useful when urogenital operation would be delayed by penile tumescence.
Intravenous infusions of ifosfamide/mesna and perturbation of warfarin anticoagulant control
Authors: Hall G , Lind M J , Huang M , Moore A , Gane A , Roberts J T , Cantwell B M J 
Published: December 2008

Summary
We report three patients who had serious disturbance of anticoagulant control while receiving ifosfamide/mesna-containing cytotoxic chemotherapy in association with warfarin. In view of the likely biological potentiation of warfarin by ifosfamide/mesna, close monitoring of anticoagulant control should be performed during the co-administration of these drugs.
Small bowel infarction associated with pancreatic glucagonoma
Authors: Earl U , Abbott C R 
Published: December 2008

Summary
An 88 year old woman presented comatose, hypothermic and hyperglycaemic. She died soon after admission and at autopsy recent small bowel infarction was found. The superior mesenteric artery was encased in a dense pancreatic mass and there was marked luminal narrowing of the vessel. Histology revealed a pancreatic glucagonoma which had metastasized to colonic submucosa and serosa.
Glucagonoma is a rare tumour and this presentation of small bowel infarction associated with pancreatic glucagonoma would appear to be a unique event.
Comparison of fine needle aspiration cytology, radioisotopic and ultrasound scanning in the management of thyroid nodules
Authors: Jones A J , Aitman T J , Edmonds C J , Burke M , Hudson E , Tellez M 
Published: December 2008

Summary
In 175 patients presenting with thyroid nodules, the diagnostic value in management of fine needle aspiration and cytology (FNAC), pertechnetate (99mTc) scanning and ultrasound imaging was examined. In 82 patients, the diagnosis was confirmed at operation; in the remaining 93, there was a follow-up period of at least 2 years. Thyroid cancer was found in 13 patients. For FNAC the sensitivity, specificity and positive predictive value for thyroid cancer were 92%, 85% and 41% respectively compared with 82%, 34% and 11% for 99mTc pertechnetate scanning, 75%, 61%, 19% for ultrasound and 73%, 58% and 19% for combined pertechnetate and ultrasound scanning. In 14% of patients, the aspirates were inadequate for cytology at the first examination.
FNAC is therefore the preferable initial investigation and usually gives results adequate for a decision on surgical or medical management. With medical management and follow-up, ultrasound is of value in defining the nodule and the appearance of the rest of the gland.
Submandibular chronic sialadenitis presenting with alcohol-induced pain
Authors: Okany C C , Akinsete I , Akinyanju O O 
Published: December 2008

Summary
A 32 year old man with alcohol-induced pain over a right submandibular swelling is described. Excision biopsy of this swelling revealed chronic sialadenitis and the symptoms promptly ceased following this excision. We speculate on the possible pathophysiological mechanism.
Localized neuropathy following jellyfish sting
Authors: Peel N , Kandler R 
Published: December 2008

Summary
This report describes the case of an 18 year old female who sustained a jellyfish sting on her right wrist. She subsequently developed complete radial, ulnar and median nerve palsies distal to the site of the sting, which recovered fully over the next 10 months. We believe this to be due to a direct neurotoxic effect of the jellyfish venom.
Hepatic infarction: an unusual complication of nephrotic syndrome in a patient with diabetes mellitus
Authors: Martinez Vea A , Garcia Ruiz C , Sauri Conejero A , Mayayo Artal E , Oliver Rotellar J A 
Published: December 2008

Summary
A 67 year old woman with widespread atherosclerosis and diabetic nephropathy manifested by nephrotic syndrome and moderate renal failure developed multiple hepatic infarctions. The infarctions were documented by computed tomographic scan and needle aspiration biopsy of the liver. Except for the nephrotic syndrome and the atherosclerosis no other cause of hepatic infarction was found.
We suggest that hepatic infarction should be considered in the thrombotic complications of the nephrotic syndrome secondary to diabetic nephropathy.
The drug management of severe alcohol withdrawal syndrome
Authors: Gillman M A , Lichtigfeld F J 
Published: December 2008

Summary
We describe the various phases of the alcohol withdrawal syndrome with special reference to the pitfalls of using neuroleptics. We outline the importance of adequate sedation using either benzodiazepines or chlormethiazole. We provide a critical appraisal of the currently employed anti-epileptic medication in the alcohol withdrawal syndrome. We also indicate the usefulness of analgesic nitrous oxide as a screening test in differentiating the cases of alcohol withdrawal syndrome needing further intensive therapy to prevent progression to delirium tremens.
An inverse relationship between serum zinc and C-reactive protein levels in acutely ill elderly hospital patients
Authors: Craig G M , Evans S J , Brayshaw B J 
Published: December 2008

Summary
Serum zinc and C-reactive protein (CRP) levels were measured in two groups of acutely ill geriatric hospital in-patients. Serum CRP levels were greater than 10 mg/l in 62% of the first group and 47% of the second. There was a significant negative correlation between zinc and CRP in both groups (r = −0.33, P &lt; 0.001, n = 103) and (r = −0.29, P &lt; 0.001, n = 135 respectively).
The serum CRP was raised in 30% of long stay patients (n = 50) and 23% of a control group of elderly hospital patients with a normal serum albumin (n = 71), but there was no correlation between zinc and CRP in these patient groups. The results indicate that an acute phase response influences serum zinc levels in acutely ill geriatric patients. There is reason to believe that a distinction should be made between true zinc deficiency and a low serum zinc secondary to acute zinc redistribution during an inflammatory response. Measurement of CRP may help to distinguish between these two situations. We advise that if the serum zinc is low and CRP is significantly raised, zinc supplements should be avoided and a source of infection should be sought. Following recovery from severe infection low serum zinc levels return to normal while elevated CRP levels fall.
Contamination of blood cultures during venepuncture: fact or myth?
Authors: Shahar E , Wohl-Gottesman B-S , Shenkman L 
Published: December 2008

Summary
Contamination of blood cultures is believed to occur mainly during the venepuncture procedure. Consequently, meticulous preparation of the venepuncture site is widely recommended. To determine whether the contamination rate is indeed affected by the quality of the antiseptic procedure at the venepuncture site, 181 paired cultures were collected from 176 patients during a 6-month period after either strict antiseptic cleansing of skin with alcohol followed by povidone-iodine, or after brief disinfection with alcohol alone.
The contamination rate was not influenced by the antiseptic procedure, and corresponded to the accepted percentage reported in most other studies. Eight false positive cultures (4.4%) were obtained after strict antisepsis of the skin and 6 (3.3%) after short simple cleansing with alcohol (P = 0.39). Our results suggest that contamination of blood cultures may not be related to the venepuncture procedure—regardless of the antiseptic technique used—but may be due to later stages of laboratory handling and processing of the specimens. Review of the literature has provided further indirect evidence to support this conclusion.
Spinal sensory radiculopathy due to Angiostrongylus cantonensis infection
Authors: Wood G , Delamont S , Whitby M , Boyle R 
Published: December 2008

Summary
The most common cause of eosinophilic meningitis is the rat lung worm Angiostrongylus cantonensis, a parasite which is endemic in the South East Asian and Pacific regions. While the typical clinical presentation is that of meningitis associated with an eosinophilic pleocytosis, a 45 year old man presented with a radiculomyelopathy, associated with an eosinophilic pleocytosis and cerebrospinal fluid antibodies to A. cantonensis but without signs or symptoms of meningitis. A worm was demonstrated on both computed tomographic myelography and magnetic resonance imaging scan of the spinal cord.
The use of erythropoietin in renal failure
Authors: Macdougall I C , Hutton R D , Coles G A , Williams J D 
Published: December 2008

Summary
The treatment of renal anaemia by recombinant human erythropoietin (EPO) is now well established. Several studies have examined the pharmacokinetics and efficacy of the drug given intravenously, intraperitoneally and subcutaneously and there is increasing evidence that the subcutaneous route has several advantages including the requirement for a lower dose. It is also important to stress the need for careful determination of baseline iron status of all patients before commencing EPO therapy. In the long term the extremely high iron stores of transfusion dependent patients will disappear. In the short term, however, the majority of the patients whose serum ferritin is less than 100 micrograms/l will require iron supplementation to allow an appropriate haemoglobin response. Alternatively, a fall in transferrin saturation to less than 20% is certainly an indication for iron supplementation and if oral iron therapy is not adequate then intravenous preparations may have to be considered. Although the anaemia of renal failure can be fully corrected by EPO, partial correction may be sufficient to reverse the problems of reduced exercise capacity, myocardial ischaemia and cardiomegaly which are frequently associated with end-stage renal disease. Partial correction will also result in a lesser rise in whole blood viscosity and, in turn, possibly reduce hypertension, thrombosis and increased peripheral resistance and thus lessen the side effects of EPO therapy.
Traumatic neuroma at the tail of the pancreas following splenectomy
Authors: Geddy P M , Venables C W 
Published: December 2008

Summary
A 50 year old man presented with abdominal pain and weight loss after a splenectomy performed 26 years ago for abdominal trauma. At laparotomy, a mass was found at the tail of the pancreas. Pathological examination showed this was a traumatic neuroma and revealed evidence of chronic pancreatitis. Traumatic neuroma may be a rare cause of a pancreatic mass, especially after previous surgery or trauma.
Serum lipoproteins and apolipoproteins in young normocholesterolaemic, non-diabetic Indian men with myocardial infarction
Authors: Sewdarsen M , Desai R K , Vythilingum S , Shah N , Rajput M C 
Published: December 2008

Summary
Serum total cholesterol, triglycerides, high density lipoprotein cholesterol, low density lipoprotein cholesterol, apolipoprotein A-I and apolipoprotein B were evaluated as potential indicators of the risk of coronary artery disease in young (&lt; 46 years) normocholesterolaemic, non-diabetic men who had previously sustained a myocardial infarction (n = 50) and in healthy age and sex matched controls (n = 122) with a similar socioeconomic background.
Significant differences were observed between patients and controls in the mean concentrations of serum total cholesterol, triglycerides, low density lipoprotein cholesterol, high density lipoprotein cholesterol and apolipoprotein B, as well as in the ratios of total cholesterol to high density lipoprotein cholesterol and apolipoprotein A-I to apolipoprotein B. No significant difference was demonstrated in the concentration of apolipoprotein A-I between the two groups. Stepwise discriminant analysis indicated that apolipoprotein B was the best discriminant between patients and controls. The percentage of exact classification was 74% in patients and 66% in controls.
When the patients were compared to a subset of controls (n = 50) matched for age and total cholesterol, significant differences were demonstrated only in the mean concentrations of apolipoprotein B. Discriminant analysis confirmed that the best single discriminating variable was apolipoprotein B.
The results therefore indicate that in young normocholesterolaemic, non-diabetic Indian men with myocardial infarction, apolipoprotein B is superior to other lipid parameters studied, as a marker for coronary artery disease.
Medical audit and formulary management: a policy for rational use of thrombolytic drugs
Authors: Morgan D J R , Sutters C A , Pugh S 
Published: December 2008

Summary
In this article we report on the development, introduction, and maintenance of a policy to promote rational use of thrombolytic drugs by hospital doctors. The work was undertaken within the framework of the voluntarily operated Riverside East drugs guide (formulary) management system (FMS). The policy was introduced in October 1988 and revised in November 1989 to coincide with the launch of the new, expensive thrombolytic drugs, alteplase (rt-PA, Actilyse) in 1988 and antistreplase (APSAC, Eminase) in 1989. Streptokinase was recommended as the first-line drug for patients who had not received it within the last 6 months. The policy was communicated to all staff in meetings and a drugs guide bulletin and reinforced by ward pharmacists.
Results over a 15 month period show voluntary compliance by prescribers with the recommended policy. One hundred and seventy-four patients (22% cardiac admissions) presented with acute myocardial infarction. Of these 43 (25%) received streptokinase, the first-line recommended drug, 7 received alteplase and none received anistreplase. The savings in drug expenditure from using streptokinase rather than alteplase or anistreplase for the 15-month period of investigation were over pounds 27,000. This work represents an example of the effectiveness of the Riverside East FMS model in influencing prescribing behaviour.
Sjögren-like pluriglandular exocrine insufficiency after drug-induced toxic epidermal necrolysis
Authors: Sabán J , Pais J R , Rodríguez J L , Boixeda D 
Published: December 2008

Summary
We present the case of a patient that progressively developed xerophthalmia, xerostomia, cutaneous xerosis and exocrine pancreatic insufficiency 3 months after metamizole-induced toxic epidermal necrolysis. Though the association of Sjögren's syndrome and exocrine pancreatic impairment is well established, the Sjögren-like syndrome after drug-induced toxic epidermal necrolysis in association with such a wide exocrine glandular insufficiency has not been previously described, to our knowledge.
Investigation of acute stroke: what is the most effective strategy?
Authors: Dunbabin D W , Sandercock P A G 
Published: December 2008

SummaryTechniques of investigation of acute stroke syndromes have progressed rapidly in recent years, outpacing developments in effective stroke treatment. The clinician is thus faced with a variety of tests, each with different cost implications and each altering management to a greater or lesser extent. This review will concentrate on the basic tests which should be performed for all strokes (full blood count, ESR, biochemical screen, blood glucose, cholesterol, syphilis serology, chest X-ray and electrocardiogram). Additional tests may be required in selected cases: CT scan to diagnose ‘non-stroke’ lesions, to exclude cerebral haemorrhage if anti-haemostatic therapy is planned, and to detect strokes which may require emergency intervention (such as cerebellar stroke with hydrocephalus); echocardiography to detect cardiac sources of emboli; and in a few cases lumbar puncture and specialized haematological tests. Other tests, which are currently research tools, may be suitable for widespread use in the future including NMR, SPECT and PET scanning.
Primary shunt hyperbilirubinaemia: a variant of the congenital dyserythropoietic anaemias
Authors: Bird A R , Knottenbelt E , Jacobs P , Maigrot J 
Published: December 2008

Summary
A 19 year old Mauritian male presented with episodic nausea, abdominal discomfort and jaundice. Unconjugated hyperbilirubinaemia and erythroid hyperplasia without dyserythropoiesis led to the diagnosis of primary shunt hyperbilirubinaemia. The similarity between congenital dyserythropoietic anaemia and this entity suggests that patients with these lesions can be considered within a single spectrum of disorders, characterized as congenital ineffective erythropoiesis.
Cerebral neoplastic angioendotheleosis complicated by hypercalcaemia
Authors: Wierzbicki A S , Gibbs J M , Lidov H G W , Lolin Y , Thomas P K 
Published: December 2008

Summary
This is a case report of a 67 year old man who presented with a fluctuating level of consciousness and myoclonic jerks caused in part by hypercalcaemia. The diagnosis of cerebral neoplastic angioendotheleosis was only made later on brain biopsy and is the first report of the occurrence of hypercalcaemia in neoplastic angioendotheleosis.
Lung function abnormalities and decline of spirometry in scleroderma: an overrated danger?
Authors: Abramson M J , Barnett A J , Littlejohn G O , Smith M M , Hall S 
Published: December 2008

Summary
To document the prevalence and progression of pulmonary involvement in scleroderma (systemic sclerosis including the CREST syndrome), the clinical notes and lung function records of 113 cases were reviewed. Lung function was normal in 39 cases, isolated impairment of DLCO was found in 38 patients, a restrictive defect was present in 27 cases and there was evidence of airflow obstruction in 9 cases. The median duration of symptoms was 10 years. Dyspnoea and an interstitial pattern on chest X-ray were associated with impaired lung function. Death during the period of review was significantly related to initial impairment of the DLCO. Sixty-six patients (53 women and 13 men) underwent repeat spirometry at least 1 year after initial testing. The rates of change in VC and FEV1 were no more rapid than would be expected for normal subjects. There was no significant difference in rates of change between men and women or between dyspnoeic patients and those who were asymptomatic. The extent of skin involvement and the presence of interstitial fibrosis on chest X-ray were unrelated to the rate of loss of lung function. It is concluded that most scleroderma patients in this study had abnormal lung function when first tested, but overall significant worsening of spirometry was not found.
Syringomyelia associated with post-meningitic spinal arachnoiditis due to Candida tropicalis
Authors: Phanthumchinda K , Kaoropthum S 
Published: December 2008

Summary
A 63 year old man who suffered from syringomyelia related to post-meningitic spinal arachnoiditis caused by Candida tropicalis is reported. The clinical syndrome of syringomyelia developed gradually and a definite diagnosis was delayed for more than 10 years. The patient has partially recovered after surgical treatment. This form of fungal infection and its delayed neurological complication in the form of syringomyelia has not been reported previously, to our knowledge.
Spiral shaped microorganisms in the human duodenal mucosa
Authors: Nakshabendi I M , Peebles S E , Lee F D , Russell R I 
Published: December 2008

Summary
A new spiral shaped microorganism, Gastrospirillum hominis, distinct from Helicobacter pylori, has recently been described in the gastric mucosa. We report a patient with duodenal erosions who was found to have these organisms in his duodenal mucosa. This bacterium is not necessarily specific to the stomach, and its association with peptic damage needs to be studied further.
Extrapulmonary lymphomatoid granulomatosis presenting as Pancoast's syndrome
Authors: Dolan G , Smith J , Reilly J T 
Published: December 2008

Summary
We report the case of a 55 year old man who presented as Pancoast's syndrome associated with a left sided Horner's syndrome, a mass in the left supraclavicular fossa and marked weakness with wasting of the left arm consistent with a left sided brachial plexus lesion. Biopsy revealed the typical features of lymphomatoid granulomatosis. Neurological involvement is a rare presenting manifestation of this uncommon disease. Lymphomatoid granulomatosis should be considered as a rare but potentially treatable cause of Pancoast's syndrome.
The successful medical management of gastric outflow obstruction associated with the use of non-steroidal anti-inflammatory drugs in the elderly
Authors: Geraghty R J , Black D , Bruce S A 
Published: December 2008

Summary
One hundred and nineteen consecutive elderly patients with endoscopically diagnosed peptic ulceration were reviewed. Associated gastric outflow obstruction was present in 10.1%. The presenting clinical features differed significantly from typical younger patients and most (11/12) were taking non-steroidal anti-inflammatory drugs, suggesting a possible role for these agents in the pathogenesis of gastric outflow obstruction. These elderly patients have been successfully managed by medical therapy alone.