bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multiple sclerosis presenting as late functional deterioration after poliomyelitis
Authors: Chroni E , Howard R S , Panayiotopoulos C P , Spencer G T 
Published: December 2008

Summary
We describe five patients with previous poliomyelitis who developed multiple sclerosis (two laboratory supported definite and three clinically definite). The initial symptoms of functional deterioration developed a mean of 30 years following poliomyelitis. Initial functional deterioration was due to progressive limb weakness or impaired mobility and in three cases this led to an initial diagnosis of post-polio muscular atrophy. The clinical diagnosis became apparent with the subsequent development of characteristic clinical features, including optic nerve, brainstem, cerebellum, and spinal cord involvement. The occurrence of multiple sclerosis in these patients emphasises that late functional deterioration may be apparently unrelated to previous poliomyelitis. Furthermore, characteristic clinical features may be masked by the severe pre-existing neuromuscular and orthopaedic impairment leading to diagnostic delay and confusion with the ill-defined clinical syndrome of progressive post-polio muscular atrophy.
A patient with co-existing bronchial carcinoid tumour and bilateral phaeochromocytoma
Authors: Chan H H L , Yeung V T F , Chow C C , Ko G T C , Cockram C S 
Published: December 2008

Abstract
We report a 31-year-old Chinese man with bronchial carcinoid tumour and bilateral phaeochromocytoma. His sister also gave a history of bilateral carotid body paraganglioma. This case demonstrates the importance of screening for other endocrine disorders in patients with foregut carcinoid tumours.
Primary hyperaldosteronism due to an adrenal adenoma in a 14-year-old boy
Authors: Rodriguez-Arnao J , Perry L , Dacie J E , Reznek R , Ross R J M 
Published: December 2008

AbstractConn’s syndrome due to an adrenal adenoma is very rare in children. This paper reports a 14-year-old boy with primary hyperaldosteronism due to an adrenal adenoma. His biochemistry data were compatible with either bilateral adrenal hyperplasia or an adrenal adenoma. A dexamethasone test did not suppress aldosterone levels. Venous catheter sampling and 75Se-selenomethylcholesterol scanning suggested that the hyperaldosteronism originated at the right adrenal. Computed tomography showed an 8-mm low-density nodule in the right adrenal gland and magnetic resonance imaging confirmed the nodule which had high signal intensity on T2-weighted images consistent with a functioning adenoma. Surgery confirmed the right adrenal adenoma, and the patient was cured by right adrenalectomy. This case illustrates the difficulty of defining the aetiology of primary hyperaldosteronism and we review the biochemical and scanning techniques available to aid in diagnosis. Hypertension is unusual in children and endocrine causes are very rare, but Conn’s syndrome should always be considered in the differential diagnosis.
Yellow nail syndrome and xanthogranulomatous pyelonephritis
Authors: Danenberg H D , Eliashar R , Flusser G , Rosenmann E , Chajek-Shaul T 
Published: December 2008

AbstractWe report a case of a 74-year-old woman exhibiting the yellow nail syndrome in association with ipsilateral xanthogranulomatous pyelonephritis. Nephrectomy resulted in complete resolution of the pleural effusion and slow improvement of the yellow nails. This report calls attention to the renal-related pleural effusion, and to the thorough investigation needed for the yellow nail syndrome.
Assessment of pancreatic duct damage following trauma: is endoscopic retrograde cholangiopancreatography the gold standard?
Authors: Doctor N , Dooley J S , Davidson B R 
Published: December 2008

Abstract
A 12-year-old girl was admitted as an emergency with blunt pancreatic trauma. Computed tomography (CT) showed an intact pancreas. She failed conservative treatment. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated division of the pancreatic duct at the neck of pancreas. At laparotomy, however, there was complete necrosis of the pancreatic head. She recovered well following enteric drainage of the body of pancreas. CT and ERCP are considered the optimal imaging for pancreatic trauma but the findings may be misleading.
Dysphagia, a reversible cause not to be forgotten
Authors: Thomas M , Haigh R A 
Published: December 2008

Abstract
An 84-year-old man presented with dysphagia two years after the onset of symptoms. Repeated assessments at both ENT and neurology clinics had not recorded any of the more classical signs of Parkinson’s disease and these did not become apparent until intercurrent illness had been treated. Once diagnosed, treatment was started and dramatic improvement was seen.
Occult small bowel adenocarcinoma complicating Crohn’s disease: a report of three cases
Authors: Gillen C D , Wilson C A , Walmsley R S , Sanders D S A , O’Dwyer S T , Allan R N 
Published: December 2008

Abstract
Three patients with Crohn’s disease are described who were treated by ileal resection for intestinal obstruction. Histological examination of the resected specimen in each case established the diagnosis of adenocarcinoma of the small intestine complicating Crohn’s disease. This diagnosis should be considered in patients with longstanding macroscopic Crohn’s disease who present with severe or recurrent symptoms. The diagnosis may not be apparent on routine radiological examination or even macroscopically at laparotomy.
Role of TSH measurements in predicting the outcome of treatment for Graves’ disease following drug therapy
Authors: Wood W E A 
Published: December 2008

Abstract
Thyroid-stimulating hormone (TSH) levels obtained one month after the cessation of anti-thyroid drug treatment were assessed retrospectively for possible use in predicting outcome in 50 patients with a clinical diagnosis of Graves’ disease. Thirty-four patients remained in remission at the end of the follow-up period and 16 patients relapsed. Although a TSH level of &lt; 1.2 mU/1 did not discriminate between the two groups, none of the 24 patients who had TSH levels of &gt; 1.2 mU/1 relapsed during the follow-up period, making early discharge from the thyroid clinic possible for these patients.
Severe theophylline poisoning: charcoal haemoperfusion or haemodialysis?
Authors: Higgins R M , Hearing S , Goldsmith D J A , Keevil B , Venning M C , Ackrill P 
Published: December 2008

Abstract
Theophylline poisoning with a blood level of 183 mg/l in a 38-year-old man was treated with activated charcoal by mouth, but despite this the blood level of theophylline rose and there was circulatory collapse with rhabdomyolysis, acute renal failure and hyperthermia. Treatment with charcoal haemoperfusion and simultaneous haemodialysis was given, followed by continuous arteriovenous haemodialysis (CAVHD). Mean extraction rates of theophylline were 26% during CAVHD, and 86% during combined dialysis and charcoal haemoperfusion. During combined treatment, the mean extraction rate of haemodialysis was 62%, compared with 48% for charcoal haemoperfusion. In summary, activated charcoal given by mouth may be unable to prevent a rise in blood levels and the development of complications after substantial theophylline overdose. If theophylline is to be removed from the blood, a combination of charcoal haemoperfusion and haemodialysis will give the best clearance, but haemodialysis alone may be effective.
Poisoning due to an over-the-counter hypnotic, Sleep-Qik (hyoscine, cyproheptadine, valerian)
Authors: Chan T Y K , Tang C H , Critchley J A J H 
Published: December 2008

Abstract
The clinical features and risk of hepatotoxicity of ‘Sleep-Qik’ (valerian dry extract 75 mg, hyoscine hydrobromide 0.25 mg, cyproheptadine hydrochloride 2 mg) were determined in 23 patients treated in our hospital between 1988 and 1991. The main clinical problems were central nervous system depression and anticholinergic poisoning. There was no clinical evidence of acute hepatitis in the 23 patients after taking an average of 2.5 g of valerian (range 0.5 to 12 g). There was no evidence of subclinical liver damage in 12 patients who had routine liver function tests performed approximately 6-12 hours after ingestion. Delayed onset of severe liver damage was excluded in 10 patients in whom a telephone follow-up was possible. However, subclinical liver dysfunction in the acute stage (onset after 12-24 hours) and in the intervening period after discharge from hospital could not be excluded. To establish the risk of hepatotoxicity in long-term users and in those taking an overdosage of valerian, a much larger study of longer duration with serial liver function tests is clearly needed.
Central pontine myelinolysis following orthotopic liver transplant: association with cyclosporine toxicity
Authors: Kabeer M H , Filo R S , Milgrom M L , Pescovitz M D , Leapman S B , Lumeng L , Jindal R M 
Published: December 2008

Abstract
Central pontine myelinolysis can occur after orthotopic liver transplantation leading to high mortality and serious morbidity. In our case, central pontine myelinolysis was associated with wide fluctuations in cyclosporine levels during an episode of hypocholesterolaemia, which may have precipitated central pontine myelinolysis.
Hypopituitarism in primary haemochromatosis; recovery after iron depletion
Authors: Gama R , Smith M J , Wright J , Marks V 
Published: December 2008

Abstract
We report a case of primary haemochromatosis complicated by anterior hypopituitarism which recovered after aggressive venesection therapy. Reversal of anterior hypopituitarism in haemochromatosis following iron depletion has not been previously described.
Malignant transformation in a fatal case of giant cell tumour of the sacrum
Authors: Crew J P , Flannery M , Manners B , Coates C J 
Published: December 2008

Abstract
Most giant cell tumours can be treated by local surgery and only rarely are they life threatening. We report a case of a giant cell tumour of the sacrum causing irresectable and fatal small bowel obstruction following malignant transformation of the tumour. The role of radiotherapy in this transformation is discussed.
Amyloid goitre and hypothyroidism secondary to cystic fibrosis
Authors: Alvarez-Sala R , Prados C , Sastre Marcos J , García Río F , Vicandi B , de Ramón A , Villamor J 
Published: December 2008

AbstractAlthough cystic fibrosis (CF) is still the most frequently fatal childhood disease, many adults now survive into their third and fourth decades. Uncommon complications of chronic diseases, such as amyloidosis, while infrequent, may now appear during the course of CF in adulthood. We present a case of a patient with CF who was diagnosed with hypothyroidism due to amyloid deposits in the thyroid.
Primary duodenal carcinoma
Authors: Adedeji O A , Trescoli-Serrano C , Garcia-Zarco M 
Published: December 2008

AbstractEight cases of primary duodenal carcinoma in a district general hospital are presented. The cases highlight the advanced state of the disease at presentation, the difficulty in diagnosis, and its poor prognosis. Duodenal carcinoma occurs in both sexes worldwide with no predisposing factors in the majority of cases. There is an increased risk in patients with familial adenomatous polyposis and adenomas of the duodenum. Duodenal carcinoma occurs about 22 years from the diagnosis of familial adenomatous polyposis in about 2% of patients, forming over 50% of upper gastrointestinal cancers occurring in these patients. Carcinomatous changes occur in 30 to 60% of duodenal villous adenomas and much less in tubulo-villous and tubular adenomas. These categories of patients should be screened and adequately followed up. Aggressive and radical surgery, even in the presence of locally advanced disease and lymph node involvement, gives a better outcome. When curative surgery is not possible, chemotherapy must accompany palliation with or without radiotherapy. Pre-operative chemotherapy may facilitate a curative radical resection. The general five-year survival is 17-33% but some centres have achieved a five-year survival of 40-60% with aggressive management of these patients.
Covert bronchogenic cyst as a cause of life-threatening cardiopulmonary impairment
Authors: Mather E A , Hogg J I C , Miller A R O 
Published: December 2008

AbstractWe present a case in which a covert bronchogenic cyst resulted in two hospital admissions within three years, the second of which was characterised by life-threatening cardiopulmonary compromise requiring sustained support on the intensive therapy unit.
The economic and quality-of-life benefits of Helicobacter pylori eradication in chronic duodenal ulcer disease--a community-based study
Authors: Phull P S , Ryder S D , Halliday D , Price A B , Levi A J , Jacyna M R 
Published: December 2008

AbstractA policy of Helicobacter pylori eradication in patients with duodenal ulceration on long-term acid-suppressing therapy was evaluated in a prospective study amongst a general practice population, with particular reference to economic and quality-of-life benefits. One hundred and sixty-eight patients on long-term acid-suppressing therapy had chronic duodenal ulcer disease of whom 88 were eligible for the study; 45 patients attended for review, with 42 testing positive for H pylori (as assessed by 13C-urea breath test). The median duration of acid-suppressing therapy was six years (maximum 15 years); 47.6% of the patients were using additional antacids and 80.9% still experienced epigastric discomfort. Two-thirds (28/42) of the patients eradicated H pylori. Successful eradication was associated with a highly significant reduction in all symptoms. At 12 months follow-up, heartburn had decreased from 28.7% to 7.1%, epigastric discomfort from 75% to 3.6%, nausea from 32.1% to 0% and wind from 50% to 0%. Of the patients that eradicated H pylori 96.4% reported an improvement in their general health compared to none of those that remained H pylori positive. Successful H pylori eradication therapy scored higher on satisfaction ratings than long-term acid-suppressing therapy. Eradication of H pylori resulted in 27/28 patients being able to discontinue acid-suppressing therapy, representing a 5.8% reduction in the use of such drugs per year in the local general practice population. A policy of H pylori eradication in chronic duodenal ulcer disease reduces the use of long-term acid-suppression therapy in general practice. This has important financial implications as well as offering considerable symptomatic benefits to the patients and improving their quality of life.
Popliteal vein thrombosis associated with femoral osteochondroma and popliteal artery pseudoaneurysm
Authors: Scott E M , White F J , Jennings P E 
Published: December 2008

Abstract
Deep vein thrombosis is a common condition thought to be caused by impaired venous blood flow or hypercoagulable blood states. However, often no predisposing cause can be found. We describe a deep vein thrombosis formed in association with femoral osteochondroma and popliteal artery pseudoaneurysm. It is an interesting combination that has only been described once before.
Pellagra complicating Crohn’s disease
Authors: Zaki I , Millard L 
Published: December 2008

Abstract
We report a 53-year-old patient with clinical features of pellagra as a complication of Crohn’s disease. His symptoms improved rapidly on taking oral nicotinic acid and vitamin B complex. We suggest the paucity of reported cases of pellagra in Crohn’s disease is a reflection of poor recognition of this complication.
The older driver--a review
Authors: Morgan R , King D 
Published: December 2008

AbstractThere are differences between elderly drivers and younger drivers in that the elderly are more likely to have cognitive, motor and sensoriperceptual deficits affecting their driving performance. The elderly driver is more likely to have a chronic illness and to be on medication, that might adversely affect driving. The elderly driver requires more study and help either by retraining or provision of adaptations to vehicles. Fitness to drive is of clinical importance to doctors in most specialities and recent studies would suggest that doctors need to be more aware of the current guidelines on driving and be prepared to offer advice.
Hyperkalaemia in diabetes: prevalence and associations
Authors: Jarman P R , Kehely A M , Mather H M 
Published: December 2008

Abstract
Hyperkalaemia is associated with diabetes, but there are no recent reports of its prevalence and associations. Serum potassium concentrations were measured in all 1764 patients attending a diabetic clinic over a 12-month period and found to be &gt; 5.0 mmol/l in 270 (15%), and &gt; 5.4 mmol/l in 67 (4%). There was no other evident cause of hyperkalaemia in 41 of these 67 patients. These data serve to highlight the risk of dangerous hyperkalaemia in diabetic patients, particularly with concurrent administration of angiotensin-converting-enzyme inhibitors and potassium-sparing diuretics.
Rapidly progressive glomerulonephritis complicating acute rheumatic fever
Authors: Akasheh M S , al-Lozi M , Affarah H B , Hajjiri F K , al-Jitawi S 
Published: December 2008

AbstractA case of acute rheumatic fever and glomerulonephritis following streptococcal throat infection is presented. The coincidence of rheumatic fever and post-streptococcal glomerulonephritis is uncommon, but well recognised. This case is of additional interest since the nephritis was crescentic.
Pure white cell aplasia and health food products
Authors: Forsyth P D , Davies J M 
Published: December 2008

Abstract
The safety of ‘health’ foods and complementary medicine products is increasingly questioned. We report a case of pure white cell aplasia developing in a patient who took a variety of such products leading to an excessive intake of zinc. Recovery was complete following the withdrawal of her ‘medications’. The aetiology of the pure white cell aplasia is discussed with respect to the ingredients of the products ingested.
The management of central post-stroke pain
Authors: Bowsher D 
Published: December 2008

Abstract
Central post-stroke pain (CPSP) used to be known as ‘thalamic syndrome’. Early post-mortem studies showed that many cases had extrathalamic lesions, and modern imaging methods have confirmed and extended these findings. CPSP affects between 2 and 6% of stroke patients, ie, there is an annual incidence in the UK of between 2000 and 6000. Most patients with CPSP appear to be younger than the general stroke population, and usually to have relatively mild motor affliction; thus they may live for many years, giving a prevalence perhaps as high as 20,000. True CPSP, characterised by a partial or total deficit for thermal and/or sharpness sensations, is best treated initially with adrenergically active antidepressants. If these do not work, mexiletine may be added in suitable cases. Recent studies suggest that stimulation of the motor cortex or spinal cord by implanted electrodes may help patients resistant to medical treatment. Positive relaxation, as an adjuvant therapy, should be used in nearly all cases. Considerable or even total relief can be achieved in almost two thirds of patients. There is evidence that the sooner antidepressant treatment is begun, the more likely the patient is to respond; time should not be wasted trying conventional analgesics, which rarely have any significant effect.
The effect of nilvadipine on bloodflow in the dorsal pedis artery in type 2 diabetic patients--a study using duplex Doppler ultrasonography
Authors: Sone H , Okuda Y , Mizutani M , Kawakami Y , Bannai C , Yamashita K 
Published: December 2008

Abstract
The effects of nilvadipine on the peripheral circulation in the lower extremities using a duplex system of two-dimensional colour and pulse Doppler ultrasonography were studied in 32 patients with type 2 diabetes mellitus and mild essential hypertension. The patients (19 men and 13 women) were randomly divided into treatment and control groups. The anatomical cross-sectional area and blood flow index of the dorsal pedis artery were determined by colour and pulse Doppler ultrasonography before and 60 min after administration of 4 mg nilvadipine or placebo. Pulse rate and blood pressure were measured simultaneously. There were no significant changes in pulse rate or blood pressure after administration of either drug. Both cross-sectional areas (from 4.3 +/- 0.4 to 5.2 +/- 0.5 mm2, p &lt; 0.05) and blood flow index (from 40.3 +/- 4.3 to 58.8 +/- 9.0, p &lt; 0.05) were significantly increased in the treatment group, whereas there were no significant changes in either measurement in the control group. The findings showed that a single administration of nilvadipine increases blood flow in the dorsal pedis arteries of diabetic patients.
Medical examinations for pilots
Authors: Nicholson P J 
Published: December 2008

Abstract
High altitude is an environment that is alien to man. Stressors associated with the mechanics of flight include motion and acceleration forces applied in three vectors and in degrees that are foreign to the human vestibular apparatus. Furthermore, the work patterns of a pilot can interfere with lifestyle and circadian rhythms. Therefore medical fitness is an important consideration in determining an individual’s suitability to exercise a pilot’s licence. The medical standards applied depend on the type of aircraft flown and the duties expected of a pilot. There are three broad categories of pilot. In ascending order of stringency of medical standards these are the private pilot, the professional pilot and the military pilot.
Anorexia nervosa--diagnosis, aetiology, and treatment
Authors: Hartman D 
Published: December 2008

Abstract
The aetiology, assessment and treatment of anorexia nervosa are reviewed in the light of the classical accounts of Morton, Lasègue and Gull. The core symptoms are deliberate weight loss, disturbed body image and amenorrhoea, and complications may include cardiac failure, electrolyte disturbances, hypothermia and osteoporosis. Common clinical findings are described. Disturbed brain serotonin activity is implicated in the aetiology of anorexia nervosa, but there is little support for the use of pharmacological treatments. Psychological theories of aetiology are discussed with reference to Bruch, Crisp, Palazzoli and Minuchin: the common theme is the reaction of the patient and her family to the physical and social changes of puberty. Individual and/or family psychotherapy is seen as central to the treatment of anorexia nervosa, and the relevant clinical research is reviewed. The roles of general practitioners, general psychiatrists and eating disorder specialists are discussed in the light of recent consensus treatment guidelines.
The effects of octreotide in a patient with Nelson’s syndrome
Authors: Kelestimur F , Utas C , Ozbakir O , Selçuklu A , Kandemir O , Ozcan N 
Published: December 2008

Abstract
We have administered octreotide, 100 micrograms tid, to a 27-year-old man with Nelson’s syndrome. After seven days of therapy, adrenocorticotropin levels fell to 54% of initial values, and some shrinkage of the tumour was observed. This study indicates that octreotide therapy may have a role in the treatment of Nelson’s syndrome.
A reader’s guide to the evaluation of prognostic studies
Authors: van Walraven C , Hébert P C 
Published: December 2008

Abstract
In this article, we review guidelines which may be used to evaluate studies documenting prognosis. We describe a clinical problem involving the prognosis of a patient in an intensive care unit. An approach to the literature search is then outlined. The results of the literature search are described and criteria for the appraisal of articles describing prognosis and prognostic factors are discussed using one article as an example.