bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hyperthyroidism and immune thrombocytopenia
Authors: Jacobs Peter , Majoos Francois , Perrotta Augustine 
Published: December 2008

SummaryHyperthyroidism and immune thrombocytopenia occurred concurrently in five patients; in a sixth, thyrotoxicosis developed after successful treatment of the thrombocytopenia. Correction of the hyperthyroidism was followed by a variable pattern of clinical response. In one case with mild asymptomatic thrombocytopenia spontaneous complete remission occurred. Two patients required adrenocorticosteroids to control severe thrombocytopenic purpura during the period of hyperthyroidism, after which complete remission occurred. Another patient with severe symptomatic thrombocytopenia remains with a partially compensated thrombocytolytic state but is without purpura and off all therapy. A fifth patient required splenectomy for drug-resistant thrombocytopenia and remains critically dependent on immunosuppressive therapy. The sixth patient had a relapse of immune thrombocytopenia with subsequent development of thyrotoxicosis but platelet count spontaneously returned to normal after correction of the hyperthyroidism. Pregnancy in two of these six patients was not associated with recurrence of either hyperthyroidism or thrombocytopenia.Management of symptomatic purpura in adults with co-existent hyperthyroidism may differ from that customarily employed since adrenocorticosteroid therapy may need to be extended until euthyroidism has been established before proceeding to splenectomy. When surgery is necessary, the risk of thyrotoxic storm should be anticipated, and the patient appropriately premedicated.
Myocardial damage due to hypokalaemia and hypophosphataemia
Authors: Frustaci Andrea , Pennestrì Faustino , Scoppetta Ciriaco 
Published: December 2008

Summary
A case of severe hypokalaemia with stupor, skeletal muscle and heart muscle damage is reported.
An initial infusion of glucose-insulin and potassium (GIK) produced a temporary clinical improvement with reduction of creatine kinase (CKMB) and elevation of serum K+. On the 4th day of treatment, neuromuscular and cardiovascular deterioration occurred accompanied by a further rise of CKMB. This deterioration was coincident with a serum phosphate of 0.26 mmol/l. The impaired left ventricular (LV) function was measured using echocardiography and detecting the ejection fraction (EF).
GIK was stopped and a potassium phosphate infusion commenced. As the phosphate and potassium deficiencies were corrected, the neuromuscular and cardiac abnormalities resolved, CKMB fell to normal and LVEF rose from 40% to 72%.
We suggest that additional cardiac damage due to hypophosphataemia may have occurred in this patient, who already had cardiac impairment as a result of profound hypokalaemia. Possible mechanisms are discussed.
An ulcerated gastric diverticulum—a rare cause of haematemesis and melaena
Authors: Gibbons C. P. , Harvey L. 
Published: December 2008

Summary
A case of recurrent intraluminal bleeding from an ulcerated gastric diverticulum is described. Difficulties in diagnosis and treatment of this rare condition are discussed. The importance of accurate preoperative diagnosis by endoscopy and barium meal is emphasized.
Probable adverse interaction between oral metoprolol and verapamil
Authors: Eisenberg J. N. , Oakley G. D. G. 
Published: December 2008

Summary
A combination of an oral beta-adrenergic blocking agent and verapamil has been advocated as a safe treatment for angina. A case of Wenckebach type atrioventricular block occurring in a patient on metoprolol and verapamil is reported. It is suggested that this combination is used with caution.
Fatal neonatal septicaemia and meningitis due to Haemophilus influenzae acquired from the mother
Authors: Chattopadhyay B. 
Published: December 2008

SummaryA fatal case of neonatal Haemophilus influenzae type b, septicaemia and meningitis is described. Although the mother was asymptomatic, maternal genital tract culture yielded H. influenzae which was indistinguishable from the strain found in the infant. Despite the rarity of this organism as a cause of neonatal sepsis, increased awareness is essential so that this important offending pathogen is not missed.
A clinical comparison of purified bovine and purified porcine insulins
Authors: Olczak S A , Greenwood R H 
Published: December 2008

Summary
Twenty four patients with established insulin dependent diabetes treated with twice daily soluble and isophane bovine insulins were changed to equivalent doses of either purified bovine Neusulin and Neuphane (Wellcome) or purified porcine Actrapid and Monotard (Novo) insulins. After 6 months treatment the porcine group showed a 35% fall in insulin binding antibodies and a 14% reduction in insulin dosage. The group changed to purified bovine insulins showed no significant change in insulin binding antibodies and no change in insulin dose. Mean blood glucose and glycosylated serum protein fell in both groups during the study period but there was no significant difference between the two groups.
The swollen leg: ultrasonographic demonstration of non-thrombotic causes
Authors: Bell J M , Ross F G M , Mackenzie S , Goddard P R 
Published: December 2008

Summary
Grey-scale ultrasound is a useful investigation in selected patients with a painful swollen leg. It is of particular value in cases in which there is a clinical suspicion of deep vein thrombosis (DVT) but other features, such as an atypical history or equivocal radiology, suggest alternative pathology. Five such cases are presented in which ultrasound showed transonic lesions. The cause of the swelling of the leg was thus shown to be ‘cystic’ in nature and therefore not due to DVT. This enabled inappropriate and potentially harmful therapy to be avoided and the correct therapy, such as surgical drainage, to be undertaken.
Anorexia nervosa and necrotizing colitis
Authors: Kaye J C , Madden M V , Leaper D J 
Published: December 2008

Summary
Anorexia nervosa is associated with a mortality approaching 5% in patients severely enough affected to warrant hospital care (Hsu, 1980). The main causes of death are inanition, electrolyte disturbances or suicide. We report here a case of necrotizing colitis associated with anorexia nervosa, an association which has not been described previously.
A mesothelioma presenting with multicentric reticulohistiocytosis
Authors: Honeybourne D , Kellett J K 
Published: December 2008

Summary
Multicentric reticulohistiocytosis is a rare disorder of the skin and joints, with characteristic histological features. An increasing number of reported cases have been associated with internal malignancy. We report a case of multicentric reticulohistiocytosis in an elderly man with mesothelioma.
Waterhouse-Friderichsen syndrome without purpura due to Haemophilus influenzae group B
Authors: Morrison U , Taylor M , Sheahan D G , Keane C T 
Published: December 2008

Summary
A second recorded case of Waterhouse-Friderichsen syndrome, without purpura, due to Haemophilus influenzae is described. It is suggested that the absence of purpura should not preclude the diagnosis of the Waterhouse-Friderichsen syndrome due to this organism.
The clinical response to treatment in adult Cushing's syndrome following remission of hypercortisolaemia
Authors: Ross E J , Linch D C 
Published: December 2008

Summary
The clinical response of 57 adult patients with Cushing's syndrome due to bilateral adrenocortical hyperplasia or adrenocortical adenoma is documented following resolution of hypercortisolaemia by various forms of treatment. Despite satisfactory biochemical remission of the disease the clinical result was far less satisfactory when assessed by persistence of obesity (55%), menstrual irregularity (41%), hypertension (29%) and insulin-dependent diabetes (22%). Myopathy, hirsuitism and psychological abnormalities persisted to a lesser extent. The mortality rate of the series over a 30 year follow-up period was 4 times that of a general population matched for sex, age and year of entry into the series. Cardiovascular disease was the cause of death in 85%. Irreparable cardiovascular disease is produced early in the course of hypercortisolaemia, emphasizing the vital importance of the earliest possible recognition and treatment of this disease.
The use of intravenous meptazinol for analgesia in colonoscopy
Authors: Barnes P R H , Williams C B , Davies R L , Childs C S B , Hedges A , Graham D 
Published: December 2008

Summary
A double blind study comparing intravenous pethidine and meptazinol has been performed to establish the efficacy and safety of meptazinol as an analgesic agent in colonoscopy. Twenty two patients received pethidine and 23 patients received meptazinol and no difference in analgesic effect or sedative effect could be demonstrated either by observer or patient assessment using a visual analogue scale. A group of 10 patients in the pethidine group and 9 in the meptazinol group had continuous recording of electrocardiogram, pulse rate and blood pressure throughout the procedure. Significant falls in both systolic and diastolic blood pressure were recorded in the pethidine group but not the meptazinol group. Benign cardiac arrhythmias were recorded in both groups before and after the administration of premedicant drug and 1 patient in each group had transient ST depression. Side effects were recorded with equal frequency in each group except for vomiting which occurred in 5 of 23 meptazinol patients but none of the pethidine patients.
Meptazinol is an effective analgesic drug in colonoscopy which produces less cardiovascular depression than pethidine and thus may be useful in selected patients especially the elderly or those with known cardiovascular disease.
Amiodarone-induced vasculitis and polyserositis
Authors: Stäubli M , Zimmermann A , Bircher J 
Published: December 2008

Summary
A dose-dependent cutaneous leukocytoclastic vasculitis developed in a 34 year old man who was given amiodarone for supraventricular tachycardias resistant to other drugs. This adverse reaction disappeared within 2 weeks after discontinuation of amiodarone despite its very long half-life of 52 days in this patient. During previous treatment periods with amiodarone, the patient had experienced photosensitivity and dose-dependent polyserositis. Since high doses of amiodarone have been recently proposed for the treatment of resistant cardiac arrhythmias, dose-dependent adverse effects as described here may be encountered with increasing frequency.
Pneumatocele formation in a patient with Proteus mirabilis pneumonia
Authors: Lysy J , Werczberger A , Globus M , Chowers I 
Published: December 2008

Summary
A rare case of pulmonary pneumatoceles complicating the course of Proteus pneumonia in an adult is described. The pneumatoceles which appeared early in the course of the pneumonia resolved completely without complications. A brief review of the literature regarding formation of cavities in Proteus pneumonia is given.
The management of liver trauma
Authors: Macfarlane R 
Published: December 2008

Summary
Despite advances in the management of liver trauma during the past 40 years, haemorrhage has remained the commonest cause of death. This article outlines the diversity of opinion between the desire to determine the extent of damage and resect devitalised tissue with its attendant risk of exacerbating haemorrhage, and the alternative of a more conservative approach.
Pacemaker discomfort induced by the wearing of seat belts
Authors: Wallis M , Todd I , Aber C P 
Published: December 2008

Summary
A survey was made of 100 consecutive pacemaker recipients to examine problems they may have experienced with seat belts whilst travelling by car, either as drivers (29 patients) or front seat passengers (50 patients). Twenty-one per cent of the drivers and 30% of the front seat passengers had experienced symptoms, usually of a mild nature. Re-siting of the generator was only necessary in 1 patient and no example of electrode displacement was observed. Suggestions are made as to how this problem might be overcome.
Cerebral systemic lupus erythematosus presenting with catatonia
Authors: Lanham J G , Brown M M , Hughes G R V 
Published: December 2008

Summary
A 13 year old girl with catatonia resulting from cerebral lupus is described. She had concurrent minor epileptic status, but abolition of her seizure activity failed to influence her catatonic state. She recovered after treatment with corticosteroids and immunosuppressive agents. Cerebral lupus should be considered in the differential diagnosis in patients presenting with catatonia.
Angioimmunoblastic lymphadenopathy, sulphasalazine exposure and villous atrophy
Authors: Smith M A , Steele P R , Youngs G R 
Published: December 2008

Summary
A woman with inflammatory lesions in the terminal ileum was treated with sulphasalazine. Nine months later she developed angioimmunoblastic lymphadenopathy and was found to have intestinal villous atrophy. Her systemic illness partially responded to oral steroids but a gluten free diet restored clinical and biochemical well being coincident with a return of her villous pattern.
Endomyocardial complications of the Churg-Strauss syndrome
Authors: Lanham J G , Cooke S , Davies J , Hughes G R V 
Published: December 2008

Summary
Although many similarities exist between the Churg-Strauss syndrome and the hypereosinophilic syndrome, these two disorders have hitherto been characterized by different types of cardiac disease. Two cases of the Churg-Strauss syndrome are described where the typical endomyocardial lesion of the hypereosinophilic syndrome dominated the clinical picture.
Primary hepatocellular carcinoma associated with Wilson's disease in a young woman
Authors: Guan R , Oon C J , Wong P K , Foong W C , Wee A 
Published: December 2008

Summary
A 27 year old woman with hepato-lenticular degeneration (Wilson's disease) was found to have primary hepatocellular carcinoma (PHC) three and a half years after she was started on treatment with D-penicillamine. The tumour was resected since when she has remained well. Her liver function tests were normal throughout the course of her disease. The available literature is reviewed and possible mechanisms for this association proposed.
Adrenal insufficiency and bilateral adrenal enlargement: demonstration by computed tomography
Authors: Wheatley T , Gallagher S , Dixon A K 
Published: December 2008

Summary
A patient presented with fever, malaise and a staphylococcal wound infection occurring 3 weeks after severe haemorrhage from a lacerated brachial artery. There were no clinical features to suggest Addison's disease but abdominal computed tomography to exclude abdominal sepsis showed bilateral adrenal gland enlargement with preservation of adrenal shape. This was consistent with resolving adrenal haemorrhage or infarction and endocrinological investigations confirmed primary adrenal failure.
Evaluation of the efficacy of flecainide acetate in the treatment of ventricular premature contractions
Authors: Muhiddin K A , Turner P , Hellestrand K , Camm A J 
Published: December 2008

Summary
The efficacy of flecainide acetate in suppressing ventricular premature contractions in 14 patients was evaluated in a double-blind, cross-over, placebo controlled, randomized and balanced study. Each treatment period was 2 weeks followed by a 3–4 d placebo washout period and the study lasted 5 weeks. Flecainide was given in a dose of 200 mg twice daily.
A significant reduction in the total number of QRS complexes in a 24 h period was observed during the active compared with placebo treatment (P&lt;0.05). In comparison with placebo, flecainide reduced the number of aberrant and premature aberrant QRS complexes (P&lt;0.01). The mean suppression rate of aberrant QRS complexes during flecainide treatment was 85.4% and that of premature aberrant complexes was 93.2%. Maximum heart rate measured by 24 h ECG decreased significantly during flecainide therapy (P&lt;0.01), although no change occurred with resting heart rate measured clinically or by ECG. Severe dizziness associated with flecainide therapy necessitated withdrawal of 2 patients from the study. A proarrhythmic effect of flecainide, ventricular tachycardia, was observed in one patient.
La toux diabolique: neurogenic tussive crisis
Authors: Jacome D E 
Published: December 2008

Summary
A 52 year old female non-smoker with multiple sclerosis had a 10 year history of frequent diurnal and nocturnal spontaneous attacks of coughing, relapsing and remitting, with typical symptoms of her illness. Otolaryngeal evaluations failed to show any lesions or vocal cord paresis, and her cardiopulmonary examinations were normal. Her attacks were greatly improved by carbamazepine and valproate sodium. I suggest that tussive crisis constitutes a paroxysmal symptom in multiple sclerosis, amenable to treatment with anticonvulsant agents.
Haemorrhage through the ampulla of Vater
Authors: Ribbans W J , Pounder R E , Lindsay I 
Published: December 2008

Summary
A patient with chronic pancreatitis presented with a series of massive upper gastrointestinal haemorrhages due to bleeding into the pancreatic duct. This report emphasizes the value of intensive investigation before surgery, since it may be impossible to identify the site of bleeding at laparotomy.
Reversible coma in Wernicke's encephalopathy
Authors: Gibb W R G , Gorsuch A N , Lees A J , Yudkin J S 
Published: December 2008

Summary
A case of coma due to Wernicke's encephalopathy complicated by respiratory failure is described. Ventilation and thiamine administration lead to recovery, although Korsakoff's psychosis and ataxia persisted. A review of similar cases of coma emphasizes the absence of diagnostic features, but that if structural disease is excluded the presence of pupillary and ocular signs may support a diagnosis of Wernicke's encephalopathy. The response to thiamine may be diagnostic as in 8 of these patients who received it, but the long-term morbidity remains high.
Acromegaly presenting as subarachnoid haemorrhage in a 76 year old woman
Authors: Beard K , Macdougall I C , Behan W M H 
Published: December 2008

Summary
Acromegaly usually presents in middle age with the gradual onset of classical signs and symptoms. We report the case of an elderly woman who presented with subarachnoid haemorrhage due to infarction of a pituitary adenoma and rupture into the subarachnoid space.
Congenital hepatic fibrosis and adult-type autosomal dominant polycystic kidney disease in a child
Authors: Lee F I , Paes A R 
Published: December 2008

Summary
This reports a family with congenital hepatic fibrosis and adult polycystic kidney disease. Adult polycystic kidney disease was present in three generations. In addition, congenital hepatic fibrosis occurred in two members of the third generation. These conditions are generally held to have different modes of inheritance and the significance of their occurrence together is not clear.
Benign gastric ulceration in a health district: incidence and presentation
Authors: Glynn M J , Kane S P 
Published: December 2008

Summary
In a survey of benign gastric ulceration conducted in the Hounslow Health District from 1981 to 1982, there was an annual incidence for this condition of 43.6 per 100,000 of the population older than 14 y, with a male:female ratio of 0.9:1. This incidence is comparable to that found in other surveys over the last 30 y, but the male:female ratio is lower than in the past. This reduction is accounted for by a rise in the peak age incidence for gastric ulcer, particularly in women, and a greater proportion of the total population in this higher age group being women. In spite of a large local Asian population, no gastric ulcers occurred in this ethnic group. Thirty-eight per cent of the patients presented with acute bleeding, and 44% of these bleeders gave a history of previous ingestion of non-steroidal anti-inflammatory drugs compared with only 14% of the non-bleeding group (P less than 0.015).
Clinical diagnosis: a post-mortem assessment of accuracy in the 1980s
Authors: Mercer J , Talbot I C 
Published: December 2008

Summary
The clinical diagnoses of a series of 400 patients dying in hospital were compared with the pathological findings at autopsy. The clinical diagnoses were precisely confirmed in only 46.75% of cases (average age 65.3 y). Potentially treatable disease was missed in 13% of patients (average age 72.7 y). The most frequent errors, both of under-diagnosis and over-diagnosis, were for pulmonary embolus, pneumonia and myocardial infarction. Over-diagnosis increased with length of hospital stay. Peritonitis and other deep-seated sepsis were surprisingly frequently missed in life. The findings closely parallel those from other units both in Britain and overseas, and suggest that there is currently a high diagnostic error rate, which varies remarkably little from one institution to another.
Diaphragmatic myasthenia in mother and child
Authors: Mier A K , Havard C W H 
Published: December 2008

Summary
A 28 year old patient with ocular myasthenia for 2 y gave birth to a baby with diaphragmatic weakness. Following delivery the mother developed severe weakness of the diaphragm and required assisted ventilation. The baby recovered spontaneously and the mother responded to treatment with plasma exchange and immunosuppression. Neither mother nor baby responded to anticholinergic drugs and in neither serum were acetyl choline receptor antibodies detected.
Live abdominal pregnancy presenting as massive rectal bleeding
Authors: Bornman P C , Collins J S , Abrahamson M J , Gilinsky N H 
Published: December 2008

Summary
A case of massive rectal bleeding resulting from the placental attachment of an abdominal pregnancy to the sigmoid colon is reported. Both mother and infant survived this rare complication which should be considered when abdominal colic and major gastrointestinal haemorrhage occur in a pregnant patient.
Carbamazepine substitution in severe partial epilepsy: implication of autoinduction of metabolism
Authors: Macphee G J A , Brodie M J 
Published: December 2008

Summary
Established partial seizures are often refractory to treatment and many patients receive polypharmacy. An attempt was made to improve seizure control with the substitution of carbamazepine (CBZ) for existing treatment in 7 consecutive unremitting cases of partial epilepsy referred by their physicians as ‘intractable’. This produced a significant improvement in control of partial (P &lt; 0.02) and secondary generalized (P &lt; 0.01) seizures, with 5 patients experiencing a 50% or greater reduction in seizure frequency. A single patient suffered a generalized seizure during the period of changeover. In 3 cases auto-induction of CBZ metabolism resulted in temporary loss of seizure control which was restored by an increase in dose. A policy of planned substitution of CBZ in partial epilepsy previously regarded as intractable may be successful in selected patients. The possible deleterious effect of CBZ auto-induction should be anticipated.
Primary hepatic pregnancy
Authors: Shukla V K , Pandey S , Pandey L K , Roy S K , Vaidya M P 
Published: December 2008

Summary
A case of a 28 weeks primary hepatic pregnancy in a 25 year old female is reported. A live male fetus weighing 1300 g was delivered after laparotomy and the placenta was left intact. The uterus was of 8 weeks size with patent tubes. The patient made an uneventful recovery.
Appendix sepsis tracking along the lateral cutaneous nerve of the thigh
Authors: Gatt D 
Published: December 2008

Summary
A patient presented with tracking of pus from a chronic appendiceal abscess along the lateral cutaneous nerve of the thigh. In the absence of such a tunnel, which is only present in a small proportion of individuals, the infection would have resulted in a subinguinal psoas abscess. Although pus may conceivably extend in any direction, the reason for this unusual complication remains poorly understood.