bluuebunny/crossref_metadata_2025_split huggingface dataset:
Human pythiosis in Thailand
Authors: Imwidthaya P 
Published: December 2008

Summary
Pythium insidiosum is a protoctista and causes diseases in plants and animals. In Thailand it can cause a unique human infection of three types.
The first type is a subcutaneous lesion in thalassaemic patients, with the pathological findings of a granulomatous reaction, diffuse infiltration, and oedema of the vessel walls. The patients responded to a saturated solution of potassium iodide. The second type is chronic inflammation and occlusion of blood vessels mainly in the lower extremities which results in gangrene or aneurysm formation. This type of infection is only found in thalassaemic patients and leads to amputation of the affected extremities or resection of the involved arteries. The third type is keratitis. This type of infection may or may not be associated with thalassaemia. The clinical signs and symptoms do not differentiate it from other types of myocotic keratitis. The patients end up with keratoplasty, evisceration or enucleation.
Thailand is an agricultural country, and there are plenty of swampy areas and several plants to support the life cycle of Pythium. Moreover, many people suffer from thalassaemia, and there is no drug available for Pythium. Pythiosis plays an important role in medicine in Thailand.
Severe dysphagia associated with major tranquillizer treatment
Authors: Hughes T A T , Shone G , Lindsay G , Wiles C M 
Published: December 2008

Summary
A 56 year old patient with psychiatric complications of systemic lupus erythematosus developed severe dysphagia complicated by weight loss and aspiration. Following investigation it was concluded that the addition of haloperidol to her treatment was the major precipitating cause and withdrawal of the drug was followed by an objective improvement in swallowing. Patients taking major transquillizers may be at increased risk of severe dysphagia; regular observation of swallowing is suggested as a useful addition to the clinical examination of these patients.
The association of systemic lupus erythematosus and myasthenia gravis
Authors: Vaiopoulos G , Sfikakis P P , Kapsimali V , Boki K , Panayiotidis P , Aessopos A , Tsokos G C , Kaklamanis P 
Published: December 2008

SummaryTwo women with the rare association of systemic lupus erythematosus (SLE) and myasthenia gravis (MG) are reported. The first patient developed SLE (arthritis, severe thymectomy for MG. The second patient developed SLE (oral ulcers, arthritis, serositis, leukopenia, high titres of anti-DNA and anti-nuclear antibodies) 4 years prior to the clinical and serological onset of MG. Lymphocyte subsets and in vitro proliferative responses of peripheral blood mononuclear cells to mitogens were normal in both patients. A review of the literature revealed 26 additional patients with definite SLE coexisting with MG. Besides the theoretical interest of this association, the differential diagnosis of fatigue in patients with SLE should always include the possibility of MG.
A virilized patient with congenital hemihypertrophy
Authors: Mark S , Clark O H , Kaplan R A 
Published: December 2008

Summary
An 18 year old woman with congenital hemihypertrophy of her left side, presented with the rapid onset of virilism, hypertension and a cushingoid appearance. A computed tomographic examination revealed adrenal and hepatic masses. Adrenocortical carcinoma was confirmed by surgical pathology. Hemihypertrophy is linked to a variety of benign and malignant disorders that usually appear during childhood. These disorders include adrenocortical carcinoma and hepatoblastoma. We bring this case to clinical attention to increase awareness that adult patients with congenital hemihypertrophy are still at a significant risk of developing neoplasms.
Bilateral foot drop, weight loss and rectal bleeding as an acute presentation of Crohn's disease
Authors: Gariballa S E , Gunasekera N P 
Published: December 2008

Summary
We report a 71 year old lady who presented with weight loss, rectal bleeding and bilateral foot drop having been previously fit and well. Clinical examination, laboratory investigation and postmortem examination confirmed the diagnosis of active Crohn's disease and acute peripheral neuropathy. The clinical course of this patient suggests that the peripheral neuropathy might have resulted from the common pathogenesis for Crohn's disease.
Haemodynamic and oxygen transport response during exchange transfusion for severe falciparum malaria
Authors: Beards S C , Joynt G M , Lipman J 
Published: December 2008

Summary
We describe the haemodynamic and oxygen transport response in a patient undergoing exchange transfusion for severe falciparum malaria. We found that exchange transfusion produced a significant increase in left ventricular stroke work index, systemic oxygen delivery and oxygen consumption. This potentially beneficial effect of exchange transfusion has not been reported previously.
Possible role of Helicobacter pylori serology in reducing endoscopy workload
Authors: Tham T C K , McLaughlin N , Hughes D F , Ferguson M , Crosbie J J , Madden M , Namnyak S , O'Connor F A 
Published: December 2008

Summary
We validated a commercial enzyme-linked immunosorbent assay (ELISA), Helico-G, in diagnosing H. pylori in 129 patients (mean age 50 years, range 15-86). We analysed the results of endoscopy against serology to see whether there was a possibility of adopting the strategy of not endoscoping dyspeptic subjects under the age of 45. H. pylori infection was considered present if either histology and/or culture were positive. The ELISA had a sensitivity of 88%, specificity of 72%, positive predictive value of 85%, negative predictive value of 77% and accuracy of 82% in detecting H. pylori. In a subgroup of 52 subjects aged 45 or less (mean age 35 years, range 15-45), 17 out of 25 patients with positive endoscopic findings were H. pylori seropositive while 16 out of 27 patients had normal endoscopic findings. Eighteen out of the 52 patients (35%) were H. pylori seronegative and normal endoscopically except for five patients (10%) who had mild to moderate oesophagitis and two who had non-erosive gastritis (4%). All patients with duodenal ulcer disease (7) were seropositive giving predictive values of positive and negative serology for a diagnosis of duodenal ulcer disease as 28% and 100%, respectively.
Therefore adopting a strategy of endoscoping subjects under the age of 45 only if they were H. pylori seropositive would have saved 35% of endoscopies in this age group but missed oesophagitis in 10%. Negative serology would tend to exclude duodenal ulcer disease while positive serology discriminates poorly for it. Serology may be a useful adjunct in screening to reduce endoscopy workload provided that patients with gastro-oesophageal reflux symptoms are excluded.
Living wills: would sick people change their minds?
Authors: Potter J M , Stewart D , Duncan G 
Published: December 2008

Summary
Patients admitted acutely to a geriatric medical unit were interviewed on admission about their opinions on cardiopulmonary resuscitation (CPR). They underwent a general examination and their mental health was documented by completing the geriatric depression scale. Those who did not wish CPR in the event of a cardiac arrest were questioned again on recovery.
Of 216 patients admitted, only three objected to answering the questions and after the other exclusion criteria were applied, 100 patients were included in the study. A total of 92% of patients wished CPR in the event of a cardiac arrest. The 8% who did not wish CPR contained more people scoring high on the geriatric depression scale. After recovery, three of that eight had changed their minds and wished CPR if required.
Patients who are acutely unwell may make decisions that are influenced by their condition at this point in time and it is important to recognize that these decisions may not be maintained. In this study, consultant geriatricians did not reflect their patients' desires in making decisions about who should receive CPR if required.
Corticosteroids: do they damage the cardiovascular system?
Authors: Maxwell Simon R J , Moots Robert J , Kendall Martin J 
Published: December 2008

Summary
Since their introduction for the treatment of rheumatoid arthritis, corticosteroids have become widely used as effective agents in the control of inflammatory diseases. Although there have been undoubted benefits upon mortality in diseases such as systemic lupus erythematosus, many patients survive only to suffer a high incidence of premature atherosclerosis. There is also evidence of increased rates of vascular mortality in other corticosteroid-treated diseases, such as rheumatoid arthritis, reversible airways obstruction and transplant recipients. Possible mechanisms of damage include elevated blood pressure, impaired glucose tolerance, dyslipidaemia, and imbalances in thrombosis and fibrinolysis. This paper reviews the clinical evidence supporting the contention that there is an excess cardiovascular mortality in steroid-treated patients and the underlying mechanisms, and points to further areas of research.
Effect on central obesity and associated disturbances of low-energy, fruit- and vegetable-enriched prudent diet in north Indians
Authors: Singh Ram B , Niaz Mohammed A , Ghosh Saraswati 
Published: December 2008

SummaryThe effects of fruit and vegetables in conjunction with low-energy diet as adjuncts to a prudent diet were compared for 6 months in a randomized, single blind trial in the management of 202 group A and 204 group B patients with acute myocardial infarction. Dietary intakes were obtained based on weighing of fruit, vegetable and legume intake and weekly diet diaries. After 6 months of follow-up, mean body weight, waist/hip ratio and glucose intolerance fell significantly in patients in group A compared with those in group B. Body weight declined by 5.3 kg in group A versus 2.2 kg in group B (95% confidence interval of difference (CI) 1.28-4.92), waist/hip ratio decreased by 0.05 in group A and 0.02 in group B (95% CI 0.01-0.10), and glucose intolerance decreased by 0.85 mmol/l in group A versus 0.19 mmol/l in group B (95% CI 0.19-1.21). There was a significant net decrease in serum triglycerides (0.18 mmol/l), systolic and diastolic blood pressures (7.9/4.7 mmHg), and a net increase in high-density lipoprotein cholesterol (0.10 mmol/l). Underlying these changes, group A patients had 393 g/day net increase in the consumption of fruit and vegetables and 1,160 kJ/day net decrease in energy intake compared to these changes in groups. Those who made greater changes in diet also had greater improvements in central obesity, glucose intolerance and in other associated disturbances.
Arterial thrombosis in the nephrotic syndrome
Authors: Fahal Ibrahim H , McClelland Peter , Hay Charles C R , Bell Gordon M 
Published: December 2008

Summary
Thrombosis is a frequent cause of morbidity and mortality in patients with the nephrotic syndrome. Venous thrombotic complications are well recognized but arterial complications are rare. Thrombosis is multifactorial, and has been attributed to a hypercoaguable state due to alterations in blood levels of the various factors involved in the coagulation and fibrinolytic systems, alterations in platelet function, venous stasis, haemoconcentration, increased blood viscosity and possibly the administration of steroids. Thrombosis in general and arterial thrombosis in particular is a significant and potentially serious problem in nephrotic patients. Awareness of the condition and its pathogenesis is needed. Assessment for the risk factors is required to allow appropriate prophylactic measures to be taken.
Hypoparathyroidism with extensive intracranial calcification: a case report
Authors: Goel A , Bhatnagar M K , Vashishta A , Verma N P S 
Published: December 2008

Summary
We present a case of hypoparathyroidism, demonstrating extensive intracranial calcification, not only in basal ganglia, but also outside the extrapyramidal system. The patient presented with an unexplained epileptifors disorder, accompanied by extrapyramidal dysfunction in the form of choreoathetosis and hemiballismus. Hemiballismus is reported for the first time to our knowledge in association with hypoparathyroidism.
High-dose intravenous gammaglobulin therapy for acquired von Willebrand disease
Authors: Van Genderen Perry J J , Papatsonis Dimitri N M , Michiels Jan J , Wielenga Jenne J , Stibbe Jeanne , Huikeshoven Frans J M 
Published: December 2008

Summary
Patients with acquired von Willebrand disease may present with severe bleeding, which is usually difficult to manage. Adequate haemostasis in acquired von Willebrand disease may be achieved with the infusion of factor VIII/von Willebrand factor concentrates or with the administration of desmopressin. We report a case of acquired von Willebrand disease with severe postoperative bleeding, responding poorly to classical von Willebrand factor replacement therapy but successfully treated with high-dose intravenous gammaglobulins. This new treatment mode of acquired von Willebrand disease is discussed in the light of a critical analysis of the literature.
The painless soft tissue mass in childhood--tumour or not?
Authors: Boothroyd A E , Carty H 
Published: December 2008

SummarySoft tissue malignancies are uncommon in adults and even rarer in children. Twelve children presented to the radiology department over a three-year period with a clinical diagnosis of a malignant lower limb mass. This diagnosis was usually based on the presence of a firm, painless mass. However, imaging revealed a heterogeneous group of benign pathologies: haemangioma (two cases), haematoma (two cases), aneurysm (two cases), and one case each of infection, myositis ossificans, Baker’s cyst, lipoma, muscle rupture, and venous malformation. During the same period there was only one malignant soft tissue neoplasm. A variety of imaging techniques were used but ultrasound combined with colour flow Doppler was the single most helpful modality. The radiological diagnosis were confirmed by biopsy, surgery or clinical follow-up.
Pancreatic ketoacidosis: ketonemia associated with acute pancreatitis
Authors: Kabadi U M 
Published: December 2008

Summary
Ketonaemia is well documented as a consequence of prolonged starvation, acute alcoholism, and uncontrolled diabetes mellitus. However, its occurrence in acute pancreatitis has not been described. In this report, three patients who manifested ketoacidosis at the time of presentation of acute pancreatitis are described. In none of these patients could ketoacidosis be attributed to any of the well known pathogenetic factors such as ethanol, diabetes mellitus or prolonged starvation. In one patient, both the serum ketone titres and increased anion gap persisted for several days during the recovery period, despite appropriate therapy (including restriction of oral intake or nasogastric suction, intravenous fluids, and analgesic administration), before declining in parallel with a decrease in serum lipase levels, and became undetectable following near normalisation of serum lipase. Therefore, we believe that pancreatic ketosis or ketoacidosis may be a distinct syndrome with ketogenesis being promoted and maintained by extremely high circulating pancreatic lipase concentrations.
Cerebral achromatopsia as a presentation of Trousseau’s syndrome
Authors: Orrell R W , James-Galton M , Stevens J M , Rossor M N 
Published: December 2008

Summary
A 67-year-old man developed a sudden onset of achromatopsia. Magnetic resonance imaging showed occipital lobe infarction. Repeated episodes of neurological deficit referable to the posterior circulation initially suggested an embolic source, but subsequently proved to be due to a coagulopathy related to a carcinoma of the bladder. This has implications for the management of patients presenting with achromatopsia, and progressive or recurrent neurological episodes, and in particular the use of anticoagulation in this situation.
Anomalous splenic artery aneurysm: demonstration on CT scanning and angiography
Authors: Sidhu P S , Khaw K T , Belli A M 
Published: December 2008

Summary
An asymptomatic 35-year-old female was found to have a congenital aneurysm of an anomalous splenic artery arising from the superior mesenteric artery on routine investigation for infertility. Demonstration on CT and angiography is presented and the pathogenesis, natural history, management, and implications during pregnancy are discussed.
Acute myelomonocytic leukaemia complicated by an acute aortic thrombosis
Authors: Leong K W , Bosco J J , Shaik I B 
Published: December 2008

Abstract
Acute aortic thrombosis is a rare condition, occurring mainly as a result of trauma or atherosclerosis and occasionally secondary to hypercoagulable states. We report a patient with relapsed acute myeloid leukaemia who developed an unusual complication, acute aortic thrombosis.
Are blood tests of value in the primary assessment and resuscitation of patients in the A&E department?
Authors: Pennycook A 
Published: December 2008

Abstract
Over a three month period an audit of the use of emergency blood tests was carried out in the accident and emergency (A&E) department at Southampton General Hospital. Few blood tests were found to be useful in the primary assessment and treatment of patients by the attending doctors. Only cross-matching of blood, an amylase level and an arterial blood gases were felt to be consistently of clinical benefit in the acute management of the patient. The reasons for inappropriate investigations and possible solutions are discussed. Significant cost savings can be made, allowing for better targeting of resources.
Descending necrotising mediastinitis
Authors: Alsoub H , Chacko K C 
Published: December 2008

AbstractDescending necrotising mediastinitis is a rare but serious complication of oropharyngeal infections with high mortality. Diagnosis is frequently delayed, contributing to this high mortality, but awareness of such a complication and early diagnosis using computed tomographic scanning leads to prompt surgical drainage, proper antibiotic therapy, and survival.
Prostate disease: management options for the primary healthcare team. Report of a working party of the British Prostate Group
Authors: Chisholm G D , Carne S J , Fitzpatrick J M , George N J , Gingell J C , Keen J W , Kirby R S , Kirk D , O’Donoghue E P N , Peeling W B , Shearer R J , Williams G B 
Published: December 2008

Abstract
The prostate gland has attracted a remarkable increase in interest in the past few years. The two most common diseases of this gland, benign prostatic hyperplasia and carcinoma of the prostate, have been brought into greater prominence by new diagnostic methods, public interest, and a wider choice of surgical and non-surgical treatments. Uncertainty about the significance of these changes has occurred because of the rapidity of change, the profusion of statements, opinions and promotions, and the relatively little guidance available from the profession. Ten urologists and two general practitioners have reviewed the relevant evidence about these two prostate diseases and the newer diagnostic methods; their conclusions are summarised here. Management options and guidance on clinical practice are also discussed. Because of a number of unresolved diagnostic and management issues, detailed requirements for practice guidelines have not been specified.
Bacteraemia with Cedecea neteri in a patient with systemic lupus erythematosus
Authors: Aguilera A , Pascual J , Loza E , Lopez J , Garcia G , Liaño F , Quereda C , Ortuño J 
Published: December 2008

Abstract
We describe a case of Cedecea neteri bacteraemia in a patient with systemic lupus erythematosus during an acute severe exacerbation of the disease, which led to her death.
Fractional excretion of potassium in normal subjects and in patients with hypokalaemia
Authors: Elisaf M , Siamopoulos K C 
Published: December 2008

Abstract
The aim of our study was the determination of fractional excretion of potassium (FEK+) in both normal subjects and hypokalaemic patients. Three hundred and twelve normal subjects aged 21-69 years and 84 hypokalaemic patients aged 36-72 years were studied. The mean FEK+ in normal subjects was 8% (range 4-16%). FEK+ was positively correlated with serum potassium (r = 0.74, p &lt; 0.0001) and inversely with serum creatinine (r = -0.51, p &lt; 0.001). The mean FEK+ in patients with hypokalaemia of external origin was 2.8% (range 1.5-6.4%). On the contrary, the mean FEK+ in hypokalaemic patients in whom renal potassium loss was the main aetiologic factor for the pathogenesis of hypokalaemia was 15% (range 9.5-24%).
High dependency units in the UK: variable size, variable character, few in number
Authors: Thompson F J , Singer M 
Published: December 2008

Abstract
An exploratory descriptive survey was conducted to determine the size and character of high dependency units (HDUs) in the UK. A telephone survey and subsequent postal questionnaire was sent to the 39 general HDUs in the UK determined by a recent survey from the Royal College of Anaesthetists; replies were received from 28. Most HDUs (82%, n = 23) were geographically distinct from the intensive care unit and varied in size from three to 13 beds, although only 64% (n = 18) reported that all beds were currently open. Nurse: patient ratios were at least 1:3. Fifty per cent of units had one or more designated consultants in charge, although only 11% (n = 3) had specifically designated consultant sessions. Junior medical cover was provided mainly by the on-call speciality term. Twenty units acted as a step-down facility for discharged intensive care unit patients and 21 offered a step-up facility for patients from general wards. Provision of facilities and levels of monitoring varied between these units. Few HDUs exist in the UK and they are variable in size and in the facilities and monitoring procedures which they provide. Future studies are urgently required to determine cost-effectiveness and outcome benefit of this intermediate care facility.
Secretory symptoms from metastatic adrenal cortical carcinoma responding to octreotide
Authors: Pandha H S , Harrington K , Saini S , Lynn J , Peters M , Waxman J 
Published: December 2008

Abstract
The prognosis of patients with metastatic adrenal cortical carcinoma is poor, and their disabling symptoms are usually unresponsive to conventional therapy. A patient with Cushing’s syndrome secondary to a secretory adrenal cortical carcinoma was treated with octreotide, endocrine therapy and chemotherapy having failed. Treatment led to a dramatic relief of her symptoms with a fall in corticosteroid secretion. Somatostatin analogue therapy for this tumour should be encouraged in view of the lack of alternative palliative treatment.
Methotrexate-induced pericarditis and pericardial effusion; first reported case
Authors: Forbat L N , Hancock B W , Gershlick A H 
Published: December 2008

Abstract
We report a case of methotrexate-induced pericarditis and pericardial effusion in a 22-year-old pregnant woman. These complications have not previously been described as isolated phenomena associated with methotrexate therapy.
Neurosarcoidosis masquerading as glioma of the optic chiasm in a child
Authors: Ng K L , McDermott N , Romanowski C A J , Jackson A 
Published: December 2008

Abstract
We present a case of sarcoidosis in a 14-year-old girl who presented with a short history of visual disturbance. Computed tomography and magnetic resonance imaging (MRI) demonstrated enlargement of the optic chiasm and prechiasmic optic nerves. Post-contrast MRI showed marginal enhancement of the affected areas of the optic pathways. A diagnosis of optic nerve glioma and arachnoid gliomatosis was made; surgical confirmation was not sought due to the risk to vision associated with biopsy. A rapid clinical deterioration led to repeat MRI which demonstrated extensive enhancing soft tissue throughout the basal cisterns with extension into the brain. Biopsy confirmed a diagnosis of sarcoidosis.