bluuebunny/crossref_metadata_2025_split huggingface dataset:
Immobilization hypercalcaemia responding to intravenous pamidronate sodium therapy
Authors: McIntyre H D , Cameron D P , Urquhart S M , Davies W E 
Published: December 2008

Summary
A 16 year old male developed symptomatic hypercalcaemia of immobilization on day 47 following a diving accident which had resulted in incomplete C4 tetraplegia. Following initial reduction in serum calcium with salmon calcitonin 100 U/day, symptomatic hypercalcaemia recurred. A single dose of 30 mg pamidronate sodium, given intravenously, caused serum calcium to fall within 48 hours. Initial mild, asymptomatic hypocalcaemia was followed by a return to sustained normocalcaemia. No major adverse reaction was encountered, and if further clinical experience confirms its efficacy, pamidronate sodium will warrant consideration as first-line therapy for immobilization hypercalcaemia.
Parathyroid hyperplasia associated with thymoma
Authors: Byrne D J , Gunn A , Davidson D L W , Paterson C R 
Published: December 2008

Summary
The case of a 65 year old female with myasthenia gravis and hypercalcaemia is presented. Failure of medical control of the myasthenia necessitated thymectomy at which time parathyroid exploration was also carried out. This revealed parathyroid hyperplasia and a thymoma. This association has not been previously documented in the literature.
Drug-induced acute liver disease
Authors: Lee M G , Hanchard B , Williams N P 
Published: December 2008

Summary
Fifty-three patients with drug-induced acute liver disease are reported. There were 35 females and 18 males with a mean age of 41 years. All but one patient had jaundice or hyperbilirubinaemia and 51 had abnormal liver enzymes. Histologically 38 patients (72%) had cholestatic injury while 15 had cytotoxic parenchymal damage. Methyldopa, chlorpropamide, chlorpromazine, halothane and the contraceptive pill accounted for 60% of cases. Fifty-one patients recovered after drug withdrawal while 2 died of hepatic failure. Drug-induced liver injury must be considered in patients presenting with evidence of hepatic disease as the majority will recover on withdrawal.
Papilloedema delaying diagnosis of Wernicke’s encephalopathy in a comatose patient
Authors: Mumford C J 
Published: December 2008

Summary
A case of acute Wernicke’s encephalopathy due to hyperemesis gravidarum is described. Florid bilateral papilloedema was present, resulting in diagnostic uncertainty and delay in treatment. Attention is drawn to the rare occurrence of papilloedema in Wernicke’s encephalopathy, and possible underlying mechanisms for this physical finding are considered.
A study of the dental health of patients undergoing heart valve surgery
Authors: Rogers S N 
Published: December 2008

Summary
The mouth is a possible source of infection in patients receiving prosthetic heart valves. In this study, the dental health of such patients was found to be very poor. Whilst most of the patients were asymptomatic, only two were dentally fit and 65% required the extraction of one or more teeth. On average, patients had not attended a dental practice for more than 9 years.
This level of dental neglect, in a group of patients particularly at risk, is alarming and this study indicates that a higher standard of oral care is still required and that a lack of symptoms does not indicate dental fitness.
Adenotonsillar hypertrophy and cor pulmonale: clinical and echocardiographic correlation
Authors: Kumar E B , Jaggarao N S V 
Published: December 2008

Summary
It is well recognized that upper airways obstruction by adenotonsillar hypertrophy can lead to cor pulmonale, but delays in diagnosis still occur, leading to an appreciable morbidity and even occasional mortality. In the case presented, echocardiographic recognition of right ventricular enlargement and abnormal pulmonary valve motion served to complement and confirm the clinical diagnosis. Following surgical relief of the airways obstruction, the echocardiographic examination usefully documented the regression in right ventricular size and the return to normality of pulmonary valve motion.
Intracranial abscess complicating diverticulitis with CT scan mimicking primary glioma
Authors: Dixon A R , Holmes J T , Waters A 
Published: December 2008

Summary
The case of a 64 year old woman with diverticulitis complicated by a metastatic cerebral abscess is reported. Presentation was atypical and investigations were misleading; the computed tomographic scan was interpreted as showing a glioma. This case demonstrates that malignancy should never be assumed and the importance of making a histological diagnosis. Once the abscess was drained the patient made a full recovery with resolution of her neurological deficits.
Meningeal infiltration by non-myelomatous IgD-secreting plasma cell dyscrasias
Authors: Yebra M , Manzano L , de la Torre A , Hornedo J , Albarran F , Menéndez J L 
Published: December 2008

Summary
Two cases of meningeal invasion by non-myelomatous plasma cell dyscrasias--a plasma cell leukaemia and an extramedullary plasmacytoma--are described. Both were secretors of IgD paraprotein and both were diagnosed in life, characteristics which we have not found in any other published case of plasma cell leptomeningitis. Analysis of our patients and of another 25 cases suggests as predisposing factors of meningeal invasion the male sex, presentation in the form of plasma cell leukaemia, presence of the IgD paraprotein and tumoral involvement of pleura, lung, pericardium and testicles.
Aggressive treatment of this neurological complication controlled the meningeal disorder in some cases. However, the majority died of disseminated disease in spite of systemic chemotherapy. Until an effective treatment can be found, able to maintain remission or cure the systemic disease, prophylaxis of the central nervous system in plasma cell dyscrasias does not appear to be advisable.
Intestinal ischaemia associated with phaeochromocytoma
Authors: Carr N D , Hulme A , Sheron N , Lees W R , Russell R C G 
Published: December 2008

Summary
The present case report describes a patient with an adrenal phaeochromocytoma who presented with infarction of the small intestine. The clinical features, diagnosis and treatment of this case are described. Despite excision of the tumour and necrotic intestine, this patient died in the postoperative period from overwhelming sepsis and multi-organ failure. Special reference is made to the delayed effects of established intestinal ischaemia on immune function and it is suggested that this was major contributory factor to the fatal outcome in the present case. The onset of gastro-intestinal symptoms in patients with phaeochromocytoma should suggest the possibility of imminent gut ischaemia and indicate the necessity for prompt excision of the tumour.
Attitudes of hospital doctors in Wales to use of intravenous fluids and antibiotics in the terminally ill
Authors: Marin P P , Bayer A J , Tomlinson A , Pathy M S J 
Published: December 2008

Summary
Decisions concerning the use of intravenous fluids and antibiotics in terminally ill patients are regularly made by hospital doctors, but there is little record of staff attitudes and current practice in Britain. A questionnaire was therefore distributed to 833 Welsh hospital doctors, citing the case of a hypothetical terminally ill patient and asking questions about medical management. Of the 448 (54%) doctors who replied, 346 (77%) had managed a similar patient recently. Intravenous fluids would be administered by 238 (53%), with 206 of these (87%) resiting the cannula as required and 62 (26%) resorting to a central venous line if there was no alternative. With increasing age and seniority doctors become conservative in their approach. Nearly all claimed that ‘ensuring the patient’s comfort’ was the reason for their decision. Only 72 (16%) would use antibiotics if the patient became pyrexial.
The results suggest that British doctors are divided in their approach to the medical management of terminally ill patients and there is a need for greater discussion and training so that all the issues involved are fully appreciated.
Single central nervous system lesions can simulate multiple sclerosis
Authors: Grosset D G , Hadley D M , Bone I 
Published: December 2008

Summary
Three cases are reported in which an initial misdiagnosis of multiple sclerosis was made. In each of these a single central nervous system lesion with space occupying effect was present. These lesions caused confusion because multiple closely running neurological tracts were affected, and there was relapse and remission in the neurological signs and symptoms produced. We conclude that such cases need careful assessment to determine whether a single structural lesion could explain the presentation. Early imaging may show remediable lesions or prevent unnecessary steroid therapy.
Intermittent absorption of warfarin caused by an unrecognized pharyngeal pouch
Authors: Ong A , Slater J D H 
Published: December 2008

Summary
An 80 year old woman on long term warfarin presented with an acute haemarthrosis of her right knee. Further investigations revealed a large pharyngeal pouch and a history of tablet regurgitation was obtained. Surgical resection was necessary 12 months later to ensure predictable absorption of orally administered drugs. The varying presentation of pharyngeal pouches and the importance of this complication are discussed.
Renal embolization for ablation of function in renal failure and hypertension
Authors: Millard F C , Hemingway A P , Cumberland D C , Brown C B 
Published: December 2008

Summary
The results of transcatheter renal artery embolization are presented in a small group of patients with end-stage renal disease. Five of the patients were suffering from severe drug-resistant hypertension, one from rejection of a renal transplant and one had heavy haematuria from a transplant kidney. All seven patients benefited from the procedure with no significant morbidity. The procedure of renal artery embolization and its potential complications are discussed. It is concluded that renal ablation by transcatheter embolization is not only effective, but also has a significantly lower morbidity and mortality than surgical nephrectomy in this group of patients with end-stage renal disease and associated problems.
Colchicine cardiotoxicity following ingestion of Gloriosa superba tubers
Authors: Mendis S 
Published: December 2008

Summary
The clinical features of colchicine toxicity in a patient following ingestion of Gloriosa superba tubers are described. Gastroenteritis, acute renal failure, cardiotoxicity and haematological abnormalities were the main toxic manifestations. There was no hypotension and no neurological manifestations. Electrocardiographic changes were noteworthy and have not been reported previously.
Does a common pathophysiological basis exist in the association of ulcerative colitis and Takayasu’s aortitis? Report of a case
Authors: Ikenaga H , Ogihara T , Iyori S , Kou S , Yoshikawa H , Okura M M 
Published: December 2008

Summary
A case of a young Japanese woman with long-standing ulcerative colitis complicated by preinfarction angina due to Takayasu’s aortitis is presented. Successful emergency aorto-coronary bypass operation was performed. Whether the association of these two diseases can be explained by a common mechanism is discussed.
Sarcoidosis presenting with an acute Guillain-Barré syndrome
Authors: Miller R , Sheron N , Semple S 
Published: December 2008

Summary
A 28 year old Caucasian male presented with an acute Guillain-Barré syndrome and bilateral facial weakness. He had an abnormal chest radiograph. Lumbar puncture revealed acellular fluid with a raised protein count and lung function tests showed a restrictive ventilatory defect. The patient deteriorated and required mechanical ventilation for 14 days. Steroids and plasmapheresis were not used and the patient spontaneously recovered. Two months after presentation limb power was almost normal but there was residual partial bilateral facial weakness. The chest radiograph remained abnormal and repeat lung function tests showed a persistent restrictive ventilatory defect and a reduced gas transfer coefficient. A transbronchial biopsy revealed non-caseating granulomata. The association between neurosarcoidosis and Guillain-Barré polyneuropathy is discussed and the literature reviewed.
Retroperitoneal lymphadenopathy in familial Mediterranean fever
Authors: Rimon D , Meir Y , Cohen L 
Published: December 2008

SummaryPeripheral lymphadenopathy is rarely observed, whereas mesenteric lymphadenopathy is found occasionally on laparotomies in patients with familial Mediterranean fever (FMF). Retroperitoneal lymphadenopathy was reported only once in an autopsy of a patient with FMF. Our case is the second one, and the first one to be diagnosed during life, by means of abdominal ultrasonography and computerized tomography. In patients with FMF, where lymph node biopsy was done, the pathological finding was non-specific lymphoid hyperplasia.
Camel bites: report of severe osteolysis as late bone complications
Authors: al-Boukai A A , Hawass N E D , Patel P J , Kolawole T M 
Published: December 2008

Summary
Four cases of severe osteolysis of bones subsequent to camel bite are described. The first had osteolysis of the ribs with traumatic diaphragmatic hernia. Two cases had similar appearances of gross osteolysis of the shafts of the radius and ulna, whilst one had osteolysis of the humeral shaft. The similarities in the radiological appearances especially of the gross osteolysis at the site of trauma are noted. The complications following mammal bites are discussed.
Hepatic abnormalities in coeliac disease: three cases of delayed diagnosis
Authors: Mitchison H C , Record C O , Bateson M C , Cobden I 
Published: December 2008

Summary
Three cases of biopsy-proven coeliac disease are presented. In each case the predominant clinical and laboratory features suggested liver disease, bowel symptoms were a minor part of the presentation and the diagnosis of coeliac disease was not reached for approximately 6 months. Liver biopsy in one case showed marked fatty change, in the other cases only mild hepatitic changes. A gluten-free diet produced resolution of symptoms and, in the patient with steatosis, normalization of liver function tests. Hepatic abnormalities have been reported in coeliac disease and the significance of these is discussed but such abnormalities are usually minor and do not obscure the underlying diagnosis. We feel that these cases serve as a salutary reminder of the protean manifestations of coeliac disease.
Hyperostosis frontalis interna, acromegaly and hyperprolactinaemia
Authors: Fulton J D , Shand J , Ritchie D , McGhee J 
Published: December 2008

Summary
The association between hyperostosis frontalis interna (HFI), acromegaly and hyperprolactinaemia was investigated. Thirty six acromegalic patients, of whom 19 had hyperprolactinaemia, were compared with 36 randomly-selected, age-sex matched controls. There was a higher prevalence of HFI in the skull X-rays of the acromegalic cohort (P = 0.0002) when compared to the control group. This difference was apparent in both men (P = 0.01) and women (P = 0.01). Acromegalic patients with hyperprolactinaemia also expressed HFI in a higher proportion of individuals than the control group (P = 0.0001). Intra- and interobserver variability was assessed and concordance with 100% and 97% in the moderate and severe HFI sub-groups. The following sub-group analysis was undertaken: acromegalics and those acromegalics with hyperprolactinaemia were compared with the controls and a highly significant distinction was confirmed (P = 0.0007 and P = 0.00001 respectively). A relationship between HFI severity and the patient's age was noted in both male and female acromegalics. Also, the severity of HFI appeared related to disease duration in female acromegalics.
The cause of HFI remains unknown but appears to be strongly associated with acromegaly, particularly in the presence of co-existent hyperprolactinaemia. The association may have symptomatic significance and the presence of HFI should be confirmed or refuted in all patients with acromegaly.
Intra-operative blood glucose and serum insulin concentrations in the surgical management of insulinoma
Authors: Krentz A J , Hale P J , Baddeley R M , Williams A C , Natrass M 
Published: December 2008

Summary
The surgical management of insulinoma is frequently complicated by difficulty in pre- and intra-operative localization of the tumour. An early and reliable post-operative indicator of successful surgery would therefore be useful in the management of this condition.
In a prospective, controlled study serial measurements of blood glucose and serum insulin concentrations were performed in 5 patients with insulinoma during surgical removal of the tumour. Results were compared with 5 patients, matched for age and body weight, undergoing abdominal surgery for non-malignant disease. Serum insulin (mean ± s.e.m.) was significantly elevated in the insulinoma patients at the start of surgery (32.1 ± 3.1 vs 6.1 ± 2.2 mU/l; P &lt; 0.01). A significant fall (P &lt; 0.01) to levels comparable with the control patients (7.5 ± 1.8 vs 10.0 ± 3.3 mU/l) occurred following removal of the tumour. We conclude that serial intra-operative measurements of serum insulin concentration are technically simple to perform and provide useful retrospective corroboration of successful surgery in patients with insulinoma.
Fatal Lyme carditis and endodermal heterotopia of the atrioventricular node
Authors: Cary N R B , Fox B , Wright D J M , Cutler S J , Shapiro L M , Grace A A 
Published: December 2008

Summary
A fatal case of Lyme carditis occurring in a Suffolk farmworker is reported. Post-mortem examination of the heart showed pericarditis, focal myocarditis and prominent endocardial and interstitial fibrosis. The additional finding of endodermal heterotopia (‘mesothelioma’) of the atrioventricular node raises the possibility that this could also be related to Lyme infection and account for the relatively frequent occurrence of atrioventricular block in this condition. Lyme disease should always be considered in a case of atrioventricular block, particularly in a young patient from a rural area. The heart block tends to improve and therefore only temporary pacing may be required.
Duodenal ulceration into the cystic artery
Authors: Ford G A , Simpson A H R W , Gear M W L , Wilkinson S P 
Published: December 2008

SummaryWe report two cases of massive gastrointestinal bleeding due to anterior duodenal ulceration into the cystic artery, with gallbladder infarction as a complication. These cases indicate the potential dangers of laser therapy or embolization in bleeding anterior duodenal ulcers penetrating the cystic artery, as such therapy will arrest blood flow through the cystic artery and may precipitate gallbladder infarction.
The cardiovascular effects of beta adrenergic agonist drugs administered by nebulisation
Authors: Flatt A , Crane J , Purdie G , Kwong T , Beasley R , Burgess C 
Published: December 2008

Summary
The cardiovascular effects of equal doses (5 mg) of nebulised fenoterol, salbutamol and terbutaline were compared in 12 healthy individuals in a double-blind, placebo-controlled study. Measurements of heart rate, blood pressure, systolic time intervals, QTc interval and T-wave amplitude were made at baseline and at 15, 30, 45, 60 and 90 minutes after nebulisation. Fenoterol caused significantly greater chronotropic electrocardiographic and inotropic effects than either salbutamol or terbutaline. The peak effects after terbutaline occurred later than those after fenoterol or salbutamol.
Enema or Picolax as preparation for flexible sigmoidoscopy?
Authors: Hickson D E G , Cox J G C , Taylor R G , Bennett J R 
Published: December 2008

Summary
Two preparations for outpatient flexible sigmoidoscopy, Picolax and Klyx enemas, have been compared in a randomized controlled trial. There was no difference in efficacy between the two preparations, but patients preferred Picolax.
Coeliac disease and collagenous colitis
Authors: O'Mahony S , Nawroz I M , Ferguson A 
Published: December 2008

Summary
We describe a case of collagenous colitis in a young man with coeliac disease who had responded clinically and histologically to a gluten-free diet three years previously. The collagenous colitis responded initially to oral corticosteroid therapy and he is now asymptomatic (and with normal rectal mucosa) on oral mesalazine. Collagenous colitis should be considered in the coeliac patient with diarrhoea despite adherence to a gluten-free diet.
Focal fatty infiltration of the liver mimicking metastatic disease
Authors: Bashir Y 
Published: December 2008

Summary
We report the mistaken diagnosis of metastatic liver disease by ultrasonography in a patient with congestive heart failure and focal fatty infiltration of the liver. Multiple echogenic space-occupying lesions in the liver can be caused by benign conditions as well as tumour deposits and in a debilitated patient the possibility of focal fatty infiltration should always be considered.
Pyoderma gangrenosum associated with erythroid hypoplasia
Authors: Wong C K , Pun K K , Lum C C M , Lee S W , Ng M M T , Wang C C L 
Published: December 2008

Summary
Pyoderma gangrenosum is most commonly associated with inflammatory bowel disease and rheumatoid arthritis, but it has been associated with various haematological malignancies. We describe its association with primary erythroid hypoplasia without thymoma in an 80 year old woman who presented with septicaemia complicating urinary tract infection. Spontaneous healing of an extensive lesion was observed.
Weber-Christian disease producing splenic vein occlusion and bleeding gastric varices: successful treatment with sclerotherapy
Authors: Heseltine D , Bramble M , Cole A , Clarke D , Castle W 
Published: December 2008

SummaryA 48 year old woman with intra-abdominal Weber-Christian disease presented with bleeding gastric varices and evidence of splenic vein occlusion. We describe the problems encountered in making this diagnosis and subsequent treatment.
Adverse effect of topical methylsalicylate ointment on warfarin anticoagulation: an unrecognized potential hazard
Authors: Yip A S B , Chow W H , Tai Y T , Cheung K L 
Published: December 2008

Summary
The adverse effect of topical methylsalicylate ointment on warfarin anticoagulation is studied in 11 patients. All patients had an abnormally elevated international normalized ratio after significant usage of topical methylsalicylate ointment as obvious from both the clinical history and a positive blood level of salicylate. Out of the 11 patients, 3 had bleeding manifestation; 2 with bruises and 1 with gastrointestinal bleeding. It is concluded that topical methylsalicylate ointment should be prescribed with care to patients on warfarin and excessive usage is to be avoided since potentially dangerous drug interaction could occur.
A critical look at nursing observations
Authors: Burroughs Janet , Hoffbrand B I 
Published: December 2008

Summary
Our experience has suggested that not only do nurses on hospital wards waste time making too many unnecessary clinical observations, but that it is very difficult to persuade them to modify the pattern of their practice.
We therefore conducted a survey by questionnaire among trained nurses in one health district of their everyday ward practice and attitudes to clinical observations. This showed that whilst a majority of nurses questioned believe in the importance of routine observations for patient care, there is a lack of consistency in the criteria and communication procedures used that must seriously limit the value of the information obtained by the individual nurse.
We believe that uncritical faith in routine observations is a barrier to rationalizing procedures to optimize efficient use of the professional skills of ward nurses in this regard. There is need for more thought to be given to the problem and in particular it is important that doctors play a more active role in decision making.