bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of methyl bromide poisoning with haemodialysis
Authors: Moosa M R , Jansen J , Edelstein C L 
Published: December 2008

Summary
Acute accidental methyl bromide poisoning was treated with haemodialysis. The treatment was successful in removing bromide from the blood but the patient persists with severe neuropsychiatric sequelae. To the best of our knowledge haemodialysis has not been used previously for the treatment of organic bromide poisoning.
A small cell bronchogenic carcinoma associated with tumoral hypophosphataemia and inappropriate antidiuresis
Authors: Robin N , Gill G , van Heyningen C , Fraser W 
Published: December 2008

Summary
A patient is described with small cell carcinoma of the lung, associated with profound hypophosphataemia and hyponatraemia. Increased phosphate excretion and inappropriately high urine osmolality were observed. The abnormalities are consistent with tumoral hypophosphataemia and inappropriate antidiuresis. These tumour-related metabolic abnormalities have only been described once before with this malignancy.
Pseudobulbar palsy associated with trismus
Authors: Lai M M , Howard R S 
Published: December 2008

Summary
A 60 year old patient presented with an acute pseudobulbar palsy associated with trismus. A computed tomography scan revealed low attenuation areas consistent with infarction affecting the genu of the internal capsules bilaterally. Trismus has not previously been described as the presenting feature of a pseudobulbar palsy.
Severe hypophosphataemia in anorexia nervosa
Authors: Cariem A K , Lemmer E R , Adams M G , Winter T A , O'Keefe S J D 
Published: December 2008

Summary
In addition to well-described acid-base and electrolyte disturbances, anorexia nervosa may be complicated by severe hypophosphataemia. We report a case of anorexia nervosa complicated by life-threatening hypophosphataemia manifesting as generalized muscle weakness and bulbar muscle dysfunction, resulting in an aspiration pneumonia and cardiorespiratory arrest.
Genetic analysis in a female manifesting haemophilia B
Authors: Palmer S , Standen G R , Yates P , Oakhill A 
Published: December 2008

Summary
A 5 year old female child presented with a psoas haematoma as the first manifestation of haemophilia B. Molecular genetic studies were performed to investigate the inheritance of the disorder and the mechanisms by which females may express the haemophilia B phenotype are discussed.
Toxic megacolon complicating chemotherapy for acute myeloid leukaemia
Authors: Wodziński M A , Snowden J A , Reilly J T 
Published: December 2008

Summary
A 43 year old woman in remission from acute myeloid leukaemia developed abdominal pain, severe melaena, diarrhoea and gram-negative septicaemia whilst severely pancytopenic following consolidation chemotherapy. Subsequently, serial abdominal X-rays showed a progressive toxic megacolon. Conservative management was attempted but, because of radiological evidence of increasing colonic dilatation and incipient perforation, an emergency defunctioning colostomy was performed. The patient recovered and 2 months later the caecostomy was reversed and a right hemicolectomy performed.
This first described case of toxic megacolon following leukaemia treatment is compared with three previously described cases following cytotoxic chemotherapy for other conditions.
Bacterial meningitis in the first three months of life
Authors: Riordan F A I , Thomson A P J , Sills J A , Hart C A 
Published: December 2008

Summary
A retrospective study of infants with bacterial meningitis admitted to our hospital during 1949-52, highlighted the lack of ‘classical’ signs of meningitis in these infants. We carried out a similar review of 44 infants aged less than three months, admitted during 1982-91. We also determined the causative organisms and their antibiotic sensitivities. Symptoms and signs were similar in the two series. Forty infants in the later series were either febrile, irritable or had seizures on the day of admission. Overall mortality fell from 30% to 11%. Between 1982 and 1991 Group B Streptocococcus and Neisseria meningitidis were the commonest causes of meningitis. All organisms, except one, were sensitive to ampicillin and/or cefotaxime. Bacterial meningitis should be suspected in young infants who are febrile, irritable or having seizures. Initial treatment with ampicillin and cefotaxime is appropriate.
Immunotherapy in the management of sepsis
Authors: Fagan E A , Singer M 
Published: December 2008

AbstractThe pathophysiological effects of severe sepsis, septic shock and related syndromes result from tissues damaged by the uncontrolled production of the mediators of inflammation. Early deaths are related primarily to the acute effects of the systemic inflammatory response. Later deaths are related more closely to the consequences of multiple organ dysfunction. Monoclonal antibodies and other immunotherapies have been developed against bacterial products, cytokines and other mediators involved in this systemic inflammatory response. Immunotherapies may improve outcome in the critically ill with sepsis if used early and as part of the therapeutic regimen of antimicrobial agents and intensive care support.
Effect of Helicobacter pylori eradication on peptic ulcer healing
Authors: O’Connor H J , Kanduru C , Bhutta A S , Meehan J M , Feeley K M , Cunnane K 
Published: December 2008

AbstractIn a prospective study designed to assess the effect of Helicobacter pylori eradication on peptic ulcer healing, 85 consecutive patients with H. pylori-positive peptic ulcer disease were treated with a triple therapy regimen consisting of colloidal bismuth subcitrate 120 mg four times daily for 28 days, with metronidazole 400 mg three times daily and tetracycline 500 mg three times daily for the first seven days of treatment. H. pylori status was assessed by CLO test and histology at least four weeks after completing therapy. Of 75 patients (88%) H. pylori-negative after therapy, 69 (92%) had healed ulcers compared with only five of 10 patients (50%) who remained H. pylori-positive (p = 0.003). Cigarette smoking had no significant effect on ulcer healing. Our results suggest that H. pylori eradication may accelerate ulcer healing and provide further evidence that an effective helicobactericidal regimen is the treatment of choice in H. pylori-positive peptic ulcer.
Improving the interpretation of electrocardiographs in an accident and emergency department
Authors: White T , Woodmansey P , Ferguson D G , Channer K S 
Published: December 2008

Abstract
In this study we have examined the ability of senior house officers in the Accident and Emergency (A&E) Department to interpret electrocardiographs (ECGs) and tested the value of a single seminar and guidelines on interpretation. We prospectively audited ECG interpretation taken from notes over a two-month period and repeated this audit following a single seminar by a consultant cardiologist and after the issue of guidelines. A formal test of interpretation of a set of 20 ECGs by senior house officers in A&E was also carried out. 245 case notes were reviewed and in one third the ECG was interpreted incorrectly by senior house officers in A&E but incorrect clinical management followed in only 3.2% of cases. Following the intervention, 242 case notes were reviewed and serious misinterpretations were halved as was the number of patients mismanaged as a result (1.7%). In conclusion, formal training in ECG interpretation can reduce serious errors.
A large volume spacer significantly reduces the effect of inhaled steroids on bone formation
Authors: Meeran K , Burrin J M , Noonan K A , Price C P , Ind P W 
Published: December 2008

AbstractInhaled steroids are increasingly advocated as first line treatment for mild asthma. Some studies suggest that inhaled steroids suppress bone formation as reflected by a fall in plasma osteocalcin. Spacers have been shown to increase the proportion of inhaled aerosol that is deposited in the lungs and to reduce the amount swallowed. We measured plasma osteocalcin levels to determine the effect on bone formation of inhaled beclomethasone dipropionate (BDP) with and without a 750 ml spacer in a double-blind, randomised, placebo-controlled, cross-over study. Twenty-six healthy male volunteers took BDP 500 micrograms (two puffs of Becloforte) together with two puffs of placebo, inhaled twice daily for seven days. One inhaler was taken directly while the other was inhaled through a 750 ml spacer. After a two week washout period, the inhalers were exchanged so that BDP was taken by the alternate route for a further seven days. Fasting plasma osteocalcin levels were measured at 09.00 h before and at the end of each week. After a week of BDP taken directly (without a spacer), osteocalcin levels fell from 11.8 (SEM 0.6) ng/ml to 9.5 (SEM 0.5) ng/ml (p &lt; 0.001). After a week of BDP taken through a spacer, osteocalcin levels fell from 12.1 (SEM 0.5) ng/ml to 11.1 (SEM 0.5) ng/ml (p &lt; 0.001). The fall in osteocalcin when a spacer was used was significantly less than when BDP was taken directly (p &lt; 0.005). This is likely to be because the systemic effects on bone are caused by swallowed rather than inhaled BDP, and this is limited by the use of a spacer. Spacers should be more widely prescribed with inhaled steroids. Further prospective studies are indicated to evaluate whether spacers protect bone mass.
Continuous ambulatory peritoneal dialysis in the elderly: a seven-year experience
Authors: Hung K Y , Hsu W A , Tsai T J , Yen C J , Hou C H , Yen T S 
Published: December 2008

Abstract
This is a retrospective comparison of the status among the elderly (&gt; or = 60 years, 23 patients) and younger patients (&lt; 60 years, 31 cases) who initiated continuous ambulatory peritoneal dialysis (CAPD) between January 1986 and December 1992 at the National Taiwan University Hospital. The distribution of underlying renal diseases differed in the two groups with diabetes (56%) as the most common disease in the elderly, in contrast to glomerulonephritis (60%) in the younger patients. Haemodialysis intolerance and patient preference were the main reasons leading to the use of CAPD in both groups. Social rehabilitation status was poorer in the elderly group. The difference in cumulative risk of the first peritonitis episode and the technique failure rate were not statistically significant. The major causes of mortality were of vascular origin in both groups. In conclusion, similarities in the technique failure rate and the cumulative risk of peritonitis imply that CAPD is an acceptable alternative long-term dialysis therapy for geriatric patients.
Toxoplasma gondii--an unusual cause of myocarditis in old age
Authors: Chapman N , MacLennan W J , Rahilly M 
Published: December 2008

Abstract
We report the case of an 86-year-old man who was admitted with congestive cardiac failure and chronic renal failure. He was previously known to have a thoracic aortic aneurysm and chronic bronchitis. There was no history of myocardial infarction but his heart failure was assumed to be due to ischaemic heart disease. Despite treatment of the heart failure the patient died. At post-mortem he was found to have Toxoplasma gondii myocarditis.
Retinal vasculitis associated with Crohn’s disease
Authors: Garcia-Diaz M , Mira M , Nevado L , Galván A , Berenguer A , Bureo J C 
Published: December 2008

Abstract
Although systemic vasculitis can be a complication of inflammatory bowel disease at several locations (skin, eyes, brain, mesentery, and lung) the association of retinal vasculitis with Crohn’s disease is rare. We studied a 26-year-old woman with biopsy-demonstrated Crohn’s disease who developed a severe bilateral retinal arteritis and phlebitis, with acute loss of vision.
Symptomatic cardiomyopathy as a presentation in Whipple’s disease
Authors: de Takats P G , de Takats D L P , Iqbal T H , Watson R D S , Sheppard M N , Cooper B T 
Published: December 2008

Abstract
A patient presenting with congestive cardiac failure and anaemia underwent investigation which led to the diagnosis of Whipple’s disease, associated with dilated cardiomyopathy. Conventional antibiotic therapy for Whipple’s disease resulted in resolution of the traditional features of Whipple’s disease and a marked improvement in the patient’s heart failure.
Surgical cure of hypertension in a patient with brainstem capillary haemangioblastoma containing neuropeptide Y
Authors: Hedderwick S A , Bishop A E , Strong A J , Ritter J M 
Published: December 2008

Abstract
We describe a 29-year-old woman with persistent arterial hypertension which resolved following complete excision of a capillary haemangioblastoma from within the spinal cord at the cervico-medullary junction. Immunohistochemical staining was positive for neuropeptide Y in capillary walls and nerves in the tumour. This raises the possibility of an association between neuropeptide Y and the central control of blood pressure in man.
Communicating with young adults with cystic fibrosis
Authors: Webb A K 
Published: December 2008

AbstractThe care of the young adult with cystic fibrosis is complex, requiring a multidisciplinary input from different carers. Communication with and education of patients covers many areas; topics may include medical and personal problems, transplantation, survival, current scientific breakthroughs and the future. Communicating in these areas with knowledgeable young adults requires skill, tact and self-education upon the part of the cystic fibrosis team.
Radiotherapy and chemotherapy for inoperable non-small cell lung cancer
Authors: Bleasdale C , Jones B 
Published: December 2008

Abstract
Non-small cell lung cancer is a major cause of mortality and significant morbidity in the UK. The majority of patients are inoperable and the optimum management of these patients requires a multidisciplinary approach involving the cooperation of respiratory physicians, thoracic surgeons and clinical oncologists (radiotherapists). Treatment techniques are constantly being refined and new approaches developed.
The changing context of undergraduate medical education
Authors: Parsell G J , Bligh J 
Published: December 2008

Abstract
It has long been recognised that intensive efforts are needed to reform medical education in order to meet the future needs of populations worldwide. Pressure for changes to the organisation, content and delivery of both undergraduate and postgraduate medical education has greatly increased in the last two decades. The experience of innovative medical schools, the emergence of learner-centred teaching methods and the implications of health-care reforms in North America and Britain are major factors influencing calls for change. The pace of change has accelerated to such an extent in recent years that progress towards widespread reform appears to be more attainable than ever before. This article provides an overview of the changing context of health-care, some patterns of existing medical education and some strategies for change.
Kerosene poisoning in children in Iraq
Authors: Nagi N A , Abdulallah Z A 
Published: December 2008

Abstract
One hundred and three children with kerosene poisoning were studied. The majority of the patients were under five years of age and included a newborn baby. More patients were seen in spring and fewer in winter months. Most of the patients were children of poor families living in overcrowded conditions. Negligence and ignorance were the main causes of poisoning. Respiratory and central nervous systems were mainly involved. Chest X-ray abnormalities were frequently seen. The patients were treated symptomatically. Only one patient died, he had been in a coma on admission to the hospital. All other patients had rapid and complete recoveries.
Post-typhoid anhidrosis: a clinical curiosity
Authors: Raveenthiran V 
Published: December 2008

Abstract
A 19-year-old girl developed generalised anhidrosis following typhoid fever. Elaborate investigations disclosed nothing abnormal. A skin biopsy revealed the presence of atrophic as well as normal eccrine glands. This appears to be the third case of its kind in the English literature. It is postulated that typhoid fever might have damaged the efferent pathway of sweating.
Angiography and the aetiology of heart failure
Authors: Brookes C I , Hart P , Keogh B E , Cleland J G 
Published: December 2008

Abstract
The diagnosis of idiopathic dilated cardiomyopathy should not be made without first performing a coronary angiogram. If the cause of heart failure is unknown this should be stated rather than attributing the cause to dilated cardiomyopathy. Severe ventricular dysfunction may improve dramatically after revascularisation in some cases of coronary disease. Preservation of R waves on the surface electrocardiogram suggests the presence of hibernating myocardium but thallium scintigraphy or positron emission tomography scanning should be employed to investigate this further.
Renal calculi in primary hyperaldosteronism
Authors: Kabadi U M 
Published: December 2008

Abstract
Increased urinary calcium (Ca++) excretion and the presence of negative Ca++ balance is well documented in primary hyperaldosteronism. However, renal calculi as a major manifestation of this disorder has not previously been described. This report describes a patient who presented with renal calculi in association with primary hyperaldosteronism. We believe that primary hyperaldosteronism was a major pathogenetic factor in the formation of renal calculi since the increased urinary excretion of Ca++ and uric acid noted at onset declined following a short-term spironolactone administration and remission from renal calculi has persisted following initial nephrolithotomy and continued spironolactone therapy, which also corrected hypertension and hypokalemia, a hallmark of this disorder.
Giant cell carcinoma of the lung
Authors: Aziz S A , Ahmad M , Shah A , Bhat G M , Lone A , Ahmad K , Bano H 
Published: December 2008

Abstract
A 50-year-old non-smoking, hypertensive female, presenting with superior vena caval compression, was found to have giant cell carcinoma of the lung. She received intensive combination chemotherapy. However she died in the following 36 hours, as a consequence of refractory hypotension.
An audit of ANCA in routine clinical practice
Authors: Edgar J D , McMillan S A , Bruce I N , Conlan S K 
Published: December 2008

Abstract
We have reviewed the medical records of 301/327 consecutive patients in whom anti-neutrophil cytoplasmic antibodies (ANCA) were detected by the Regional Immunology Laboratory in Northern Ireland between January 1988 and October 1991 (45 months). We have collected data for each patient regarding age, sex, smoking habit, area of residence, and details of any other autoantibody activity. Clinical diagnosis was established, with the number of organ systems involved and the evidence for that involvement (symptomatic, biochemical, radiological, and histological). Diagnoses were divided into four groups according to their recognised vasculitic features and these were related to the pattern of immunofluorescence and maximum ANCA titre detected. The most frequent diagnosis was rheumatoid arthritis (18.2% of patients) and the connective tissue disorders as a whole accounted for 27.9% of patients. ANCA were also detected in a wide range of clinical conditions which are not associated with vasculitis and these patients were an important source of ‘false-positives’. The positive predictive value (PPV) of ANCA of all patterns and titres for vasculitic conditions was 27%, however, the detection of a classical ANCA pattern at high titre (&gt; or = 1:640) was associated with an increased PPV of 75%. The coexistence of an antinuclear antibody (ANA) reduces the PPV of both classical and perinuclear ANCA, although perinuclear ANCA with antimyeloperoxidase specificity had an improved PPV. We conclude that ANCA testing should not be used as the only screening investigation for vasculitis but should be included in a rational investigative scheme. The interpretation of a positive ANCA result must take into account the presence of other autoantibodies and the full range of non-vasculitic conditions when the clinical situation is not typical of vasculitis.
Dealing with the difficult patient
Authors: Smith S 
Published: December 2008

Abstract
Dealing with difficult patients can represent a significant burden in the life of doctors. It is more productive, however, to view this burden as a product of the interaction between doctor and patient, for which both have a responsibility, rather than attributing any problems encountered to shortcomings of the patient alone. There is a significant risk in such situations of potentially harmful over-medicalisation. It behoves doctors, therefore, to try to prevent such problems becoming established, or make some attempt to rectify matters if they have already become so. Much is known about the factors that contribute to successful and unsuccessful clinical transactions. The awareness of what doctors bring both as professionals and as individual people to this interaction, will count as much as the practical clinical efforts made towards helping patients.
Unrestricted availability of a plasma paracetamol assay service resulting in an increased number of inappropriate requests
Authors: Chan T Y , Critchley J A , Ho C S , Chan A Y 
Published: December 2008

Abstract
Previously, prior approval from the on-call chemical pathologist was required in our hospital for plasma paracetamol measurements. However, since May 1992, there have been no restrictions on ordering this assay. We have assessed the consequences of this policy change by comparing the number and appropriateness of requests for plasma paracetamol measurements in Chinese patients admitted to our hospital with acute poisoning over two six-month periods (July-December) in 1991 and 1993. Requests were considered appropriate if paracetamol ingestion was suspected or unknown drugs were ingested. The number of patients having plasma paracetamol concentrations assayed increased from 51 in 1991 to 141 in 1993 (176%). The corresponding increase in the number of Chinese patients admitted to two of our eight general wards with poisoning was estimated to be 93%. The proportion of ‘appropriate’ plasma paracetamol measurements dropped from 55% in 1991 to 21% in 1993. Eight patients had plasma paracetamol concentrations above the recommended treatment line; they were all from the group in whom the requests were appropriate. Three of the 135 patients in the group with ‘inappropriate’ requests were found to have slightly elevated but far from toxic plasma paracetamol concentrations. Unrestricted availability of plasma paracetamol measurements resulted in an increase in the number of inappropriate requests.
Giant retroperitoneal hemangiopericytoma
Authors: Chan S C , Lee C M , Ng Y B , Tsai C H 
Published: December 2008

Abstract
Hemangiopericytomas are rare vascular tumours that are derived from pericytes. Retroperitoneal hemangiopericytomas are usually bulky but clinically silent when diagnosed because of their slow rate of growth. A 49-year-old man, who presented with only vague symptoms of abdominal fullness for several months, was found on computed tomography to have a huge well-defined mass with areas of low attenuation and well-enhanced septa. The tumour was successfully resected and was confirmed to be a malignant retroperitoneal hemangiopericytoma. It measured 30 cm in the greatest dimension. We are prompted to present this case as it is believed to be the largest tumour reported to date.