bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute viral hepatitis, intravascular haemolysis, severe hyperbilirubinaemia and renal failure in glucose-6-phosphate dehydrogenase deficient patients
Authors: Agarwal R K , Moudgil A , Kishore K , Srivastava R N , Tandon R K 
Published: December 2008

Summary
Five patients with acute viral hepatitis developed severe intrasvascular haemolysis and unusually high levels of serum bilirubin (427 to 1368 mumol/l). All 5 had high fever, marked anaemia, reticulocytosis and neutrophilic leucocytosis. Three of them developed acute renal failure, which was of non-oliguric type in 2. The clinical course was protracted, but complete recovery occurred in 4 patients between 4 to 10 weeks. One patient with hepatic coma and oliguric renal failure died. Deficiency of the enzyme G-6-PD was confirmed in 4 cases. Massive haemolysis in the patients was probably induced by the administration of chloroquine and other drugs. Intravascular haemolysis should be suspected in patients with acute viral hepatitis, if they show unexplained anaemia and very high serum bilirubin levels, and measures to prevent renal failure should be instituted in such cases.
Abnormalities of thyroid function tests in hospital inpatients
Authors: Sheppard M C , Ramsden D B 
Published: December 2008

Summary
Results of thyroid function tests were analysed in 199 clinically euthyroid inpatients with normal serum thyroid stimulating hormone values. Serum total triiodothyronine was &lt; 1.25 nmol/l in 61.8% of samples, free triiodothyronine less than 3.9 pmol/l in 57.8%, total thyroxine less than 63 nmol/l in 21.1% and free thyroxine less than 9.5 pmol/l in 17.6%. In contrast, thyroxine binding globulin ratio was below normal (&lt; 5) in only 5 samples. A significant positive correlation (P &lt; 0.001) of serum free thyroxine with total thyroxine, thyroxine/thyroxine binding globulin ratio and free triiodothyronine was present as well as a significant negative correlation (P &lt; 0.001) with serum thyroid stimulating hormone. There was no correlation of free thyroxine measurements with serum albumin or non-esterified fatty acid concentrations. Although serum free thyroxine is low in a number of patients with non-thyroidal illnesses, this does not appear to be due to a rise in non-esterified fatty acids or a fall in albumin as has been proposed. Serum thyroid stimulating hormone measurements are essential to confirm the diagnosis of hypothyroidism in such subjects.
Prognosis in hypertrophic cardiomyopathy with asymmetric septal hypertrophy
Authors: Wadehra Dwarka , Gunnar Rolf M , Scanlon Patrick J 
Published: December 2008

Summary
Hypertrophic cardiomyopathy with asymmetric septal hypertrophy is not an uncommon disorder in the older adult population, and frequently masquerades as coronary artery disease. Most symptomatic patients with hypertrophic cardiomyopathy diagnosed as adults have a benign course with mild disability lasting for many years. Associated significant obstructive coronary artery disease was present in 22% of our patients and probably represents the cause of symptoms and, therefore, investigation in some of our patients rather than a high incidence of coronary disease in patients with asymmetric septal hypertrophy. Sudden death was not common in our patients (3.6%) and occurred at 11 years after diagnosis in a patient with associated coronary artery disease and 4 years after diagnostic study in a patient with uncomplicated hypertrophic cardiomyopathy.
Levodopa withdrawal syndrome identical to neuroleptic malignant syndrome
Authors: Gibb W R G , Griffith D N W 
Published: December 2008

Summary
A 60 year old woman with idiopathic Parkinson's disease had been prescribed thioridazine for schizophrenia. Five months after this was stopped, Sinemet also considered of dubious therapeutic value, was withdrawn. One week later she developed features of the neuroleptic malignant syndrome (NMS) accompanied by myoglobinuric renal failure. Post-mortem examination confirmed Lewy body degeneration in the substantia nigra. It is proposed that NMS may be caused by levodopa withdrawal in Parkinson's disease, and that it is withdrawal of dopaminergic drive that causes the syndrome.
The prognostic value of blood glucose and glycosylated haemoglobin estimation in patients with stroke
Authors: Cox N H , Lorains J W 
Published: December 2008

SummaryIn a prospective study of 109 patients admitted to hospital with a provisional diagnosis of acute stroke, 87 were found to have acute hemiplegic stroke lasting more than 24 hours, and did not have any other co-existing life-threatening disorder. In 81 of these patients, blood glucose and glycosylated haemoglobin (HbA1) were measured at the time of admission. Thirteen of these 81 patients (16%) were hyperglycaemic—in 5 cases, normal HbA1 was found in conjunction with hyperglycaemia suggesting that this represented a ‘stress’ response. There was no significant difference in age or in blood glucose level between those who died as a result of stroke and those who survived. However, hyperglycaemia with normal HbA1 was demonstrated in 4 of 26 patients who died compared to only one of 55 survivors (P &lt; 0.02), and all 3 patients with blood glucose greater than 10 mmol/l in conjunction with normal HbA1 died as a result of stroke. Biochemical evidence of ‘stress’ hyperglycaemia in patients with acute stroke suggests a poor prognosis.
Focal myositis and elevated creatine kinase levels in a patient with phaeochromocytoma
Authors: Bhatnagar D , Carey P , Pollard A 
Published: December 2008

Summary
A case of phaeochromocytoma with marked transient elevation of creatine kinase levels is presented. No obvious cause for the elevation was found in life, but on autopsy a non-specific focal myositis was discovered. Possible reasons for the raised creatine kinase levels and focal myositis are discussed.
Short PR intervals and tachyarrhythmias in Fabry's disease
Authors: Efthimiou J , McLelland J , Betteridge D J 
Published: December 2008

Summary
Two brothers with Fabry's disease presenting with palpitations were found to have intermittent supraventricular tachycardias. Their electrocardiograms, when symptom-free, revealed short PR intervals consistent with ventricular pre-excitation. Treatment of one of the brothers with verapamil resulted in improvement of the palpitations and reduction in frequency of the tachycardia. Recurrent supraventricular tachycardia associated with ventricular pre-excitation has not previously been described in Fabry's disease. Evidence suggests that this complication may be due to glycolipid deposition in the conducting system around the atrioventricular node.
Asymptomatic Graves' disease during lithium therapy
Authors: Thompson C J , Baylis P H 
Published: December 2008

Summary
Lithium salts are widely recognized to cause biochemical hypothyroidism and have been used to treat thyrotoxicosis. We present a case of Graves' disease which developed during lithium therapy. The patient was asymptomatic until the lithium was discontinued; she subsequently developed florid symptoms of thyrotoxicosis.
Acute sulphasalazine hepatotoxicity
Authors: Jennings P E , Blandford R L , Rosenthal F D 
Published: December 2008

Summary
We describe a case of severe sulphasalazine hepatotoxicity. The features described are those of an acute hypersensitivity reaction which responded to drug withdrawal alone as steroids were withheld. Supportive treatment only is recommended for this potentially fatal condition.
Ulcerative colitis and sarcoidosis
Authors: Barr G D , Shale D J , Jewell D P 
Published: December 2008

Summary
Ulcerative colitis is not commonly associated with recognizable pulmonary disease and only four sporadic cases of sarcoidosis in association with ulcerative colitis have been previously reported. However, in a series of 680 patients with ulcerative colitis, pulmonary or extra-pulmonary sarcoidosis has at some stage been present in eight. These cases are reported in detail. The onset of either condition bore no relationship to the activity or the presence of recognized peripheral manifestations of the other, suggesting that the two diseases were independent. However, three of the patients had the HLA B8 DR3 phenotype which is a higher prevalence than seen in previous studies of either disease alone. Patients with ulcerative colitis who possess this HLA phenotype may possibly be more susceptible to developing sarcoidosis.
Malignant melanoma involving the small bowel
Authors: Wilson B G , Anderson J R 
Published: December 2008

Summary
Small bowel is the commonest site of gastrointestinal metastases from cutaneous malignant melanoma. Five patients with malignant melanoma involving the small bowel are reported. One patient was operated on for suspected acute appendicitis, two patients for gastrointestinal bleeding and two patients for small bowel obstruction. Two patients remain well 4 and 5 years after surgery.
Paroxysmal atrial fibrillation associated with an attack of multiple sclerosis
Authors: Chagnac Y , Martinovits G , Tadmor R , Goldhammer Y 
Published: December 2008

Summary
A young woman presented with an acute right pontine lesion and paroxysmal atrial fibrillation. The lesion was later proven by magnetic resonance imaging to be due to multiple sclerosis. To our knowledge, cardiac arrhythmias have not been previously described in this condition. Published support for this possible association is reviewed.
Hypercalcaemia in chronic lymphatic leukaemia
Authors: Macintyre E A 
Published: December 2008

Summary
A 75 year old woman with a 13 year history of classical chronic lymphatic leukaemia (CLL) developed hypercalcaemia. Unlike previous reports, this was not associated with blastic transformation, hyperparathyroidism or features of multiple myeloma, but was due to classical CLL per se.
Chronic hypernatraemia and hypothermia following subarachnoid haemorrhage
Authors: Nussey S S , Ang V T Y , Jenkins J S 
Published: December 2008

Summary
We describe a 30 year old man who developed chronic adipsic hypernatraemia and hypothermia following a subarachnoid haemorrhage from an anterior communicating artery aneurysm. Anterior pituitary function tests were normal. Hypothermia was demonstrated over 4 years with loss of the ability to control heat conservation despite body temperatures as low as 30°C. He failed to experience thirst despite plasma sodium concentrations of up to 187 nmol/l and plasma osmolalities of up to 397 mOsm/kg. The slope of the plasma vasopressin-plasma osmolality curve indicated loss of the osmoreceptor. There was an absent vasopressin response to insulin-induced hypoglycaemia but a normal response to apomorphine. The apomorphine-stimulated immunoreactive vasopressin was shown to behave identically to the synthetic peptide on HPLC and was bioactive.
Sick sinus syndrome aggravated by carbamazepine therapy for epilepsy
Authors: Hewetson K A , Ritch A E S , Watson R D S 
Published: December 2008

SummaryA case of sick sinus syndrome aggravated by carbamazepine prescribed for epilepsy is described. A 70 year old woman with previously stable psychomotor epilepsy experienced syncope of increased frequency after her anticonvulsant was changed to carbamazepine. ECG monitoring confirmed a severe sick sinus syndrome which improved on carbamazepine withdrawal. Failure to distinguish carbamazepine-induced cardiac syncope from epileptic attacks may lead to an increase in dosage and aggravation of syncope.
Is inotropic therapy appropriate for patients with chronic congestive heart failure? Or is the digitalis leaf withering?
Authors: Uretsky B F 
Published: December 2008

SummaryThe appropriateness of inotropic therapy in chronic heart failure was examined by critically reviewing five assumptions upon which this form of therapy has been justified. Only the first, that cardiac performance can be acutely improved by inotropic therapy, has been empirically proven. That such acute improvement is sustained appears to be true with non-catecholamine agents whereas the chronic haemodynamic efficacy of oral catecholamines remains in doubt. That any inotropic agent can improve exercise tolerance, make the patient feel better, or effect a change without deleteriously affecting the myocyte is very much in doubt. Thus, although the prospect of using powerful inotropic therapy in the patient with heart failure is theoretically appealing, its utility remains to be proven.
The heart in Portuguese amyloidosis
Authors: de Freitas A F 
Published: December 2008

Summary
A systematic investigation was performed in patients with familial amyloidotic polyneuropathy, Portuguese type (AFp) to assess the pattern and incidence of cardiac involvement. Of 327 patients investigated, ECG abnormalities were present in 285 (87.2%). Low voltage and QS pattern in V1, V2, V3 were found in 51.3% and 35.7% patients respectively. Conduction disturbances were present in 211 (64.5%). Sinus node disease, 1st degree and Wenckebach interventricular blocks were frequent. Complete atrioventricular block was observed in only 2 patients (0.6%). Left anterior hemi-block was present in 30.8%, left bundle branch block in 3.9%, left posterior hemi-block in 2.4% and right bundle branch block in 2.1%. Holter monitoring showed a much higher incidence of conduction disturbances, most of these occurring at night.
The mean values of septum and posterior wall thickness and mass evaluated by echocardiography in 72 patients were normal. The systolic and diastolic global and regional functions, determined in 12 patients, analysing the echo by a digitization computer technique, were normal. In 7% a trivial pericardial effusion was observed. In 16 patients with ECG changes and normal echocardiograms the technetium 99m pyrophosphate scanning was negative.
We conclude that the ECG is the most precise, sensitive and clinically useful method for detecting cardiac amyloidosis in patients with AFp. In spite of the rarity of congestive and restrictive patterns, the incidence and severity of conduction disturbances does not allow us to consider heart disease in AFp as a benign entity.
Septicaemia and pleural effusion due to Plesiomonas shigelloides
Authors: Humphreys H , Keogh B , Keane C T 
Published: December 2008

Summary
Plesiomonas shigelloides is a rare cause of invasive infection, most clinically significant isolates being from the gastrointestinal tract of animals and man. Recently it has been implicated as an increasing cause of opportunistic infections.
We report a case of P. shigelloides septicaemia and pleural effusion in a patient with pre-existing alcoholic liver disease. This case serves to illustrate the possible role of P. shigelloides as an opportunistic pathogen in a compromised host especially where there is co-existing liver disease.
Azathioprine shock
Authors: Rosenthal E 
Published: December 2008

Summary
Azathioprine has been used as an immunosuppressant for over 20 years in cancer chemotherapy, organ transplantation and diseases with confirmed or suspected immune mechanisms. A hypersensitivity reaction manifesting as fever, rash, myalgia and a neutrophil leucocytosis occurring about 2 weeks after exposure is well documented and has been confirmed by challenge testing. Hypotensive reactions are less common but potentially fatal; a case is reported where repeat exposure resulted in profound circulatory collapse responding only to intervention with inotropic agents.
Hypoglycaemic coma associated with gastric carcinoma
Authors: Macdougall I C , Fleming S , Frier B M 
Published: December 2008

Summary
Gastric carcinoma may rarely be the cause of tumour-associated hypoglycaemia. We report the case of an elderly woman who presented in hypoglycaemic coma, and who was found subsequently to have an adenocarcinoma of the stomach. Hypoglycaemia persisted despite prednisolone, diazoxide, and a high concentration dextrose infusion. The few published cases are reviewed in which an association was established between gastric carcinoma and hypoglycaemia, and the possible aetiology of the hypoglycaemia is discussed.
Stress and heart disease: evidence of associations between unemployment and heart disease from the OPCS Longitudinal Study
Authors: Moser K A , Fox A J , Goldblatt P O , Jones D R 
Published: December 2008

Summary
The OPCS Longitudinal Study has been used to study both overall and cause-specific mortality patterns in 1971–1981 among men and women directly or indirectly affected by unemployment in April 1971. Groups studied included men seeking work in 1971, the wives of men seeking work in 1971 and other women in the same households as a man seeking work in 1971. The findings of this project are summarized here and attention is focused on mortality from circulatory diseases, in particular ischaemic heart disease. The study provides evidence which could be seen as supporting hypotheses about relationships between stress and overall mortality, with a marked excess for suicides. The evidence with respect to ischaemic heart disease is positive but less convincing with excess mortality from this cause principally occurring among younger unemployed men and among the wives of men who were seeking work in 1971. Given the sharp contrasts in the pattern and levels of unemployment between 1971 and 1981 it is difficult to extrapolate from these findings to the present day.
The development of diabetes mellitus and chronic liver disease in long term chelated beta thalassaemic patients
Authors: De Sanctis V , D'Ascola G , Wonke B 
Published: December 2008

Summary
We studied 29 patients with thalassaemia major who had received intensive chelation for between 6.2 and 8.8 years. All patients had normal oral glucose tolerance tests before subcutaneous chelation therapy was introduced and 22 of 29 patients had normal liver function tests. At the end of the period of study 12 patients still had normal oral glucose tolerance (7 with normal liver function tests and 5 with chronic active hepatitis). On the other hand, 11 patients had developed impaired glucose tolerance tests (3 patients had normal liver function tests, 5 with chronic active hepatitis and 3 with cirrhosis), and 6 patients had developed frank diabetes mellitus (one with chronic active hepatitis and 5 with cirrhosis). Patients with chronic active hepatitis showed 91% positivity for one or more hepatitis B markers whilst all patients with cirrhosis were positive. Ferritin levels before subcutaneous chelation in patients with normal oral glucose tolerance tests were lower than in those patients with abnormal oral glucose tolerance or diabetes (P &lt; 0.05) but none had normal serum ferritin levels. In addition, a positive correlation was found between glucose area under the curve after chelation therapy and serum ferritin levels (r = 0.47, P &lt; 0.01).
It is apparent that long term chelation therapy does not prevent the development of abnormal oral glucose tolerance in chronically transfused patients. More intensive chelation therapy is needed to prevent tissue damage. Chronic liver disease may have an important role to play in the deterioration of glucose tolerance.
Obstruction of the third part of the duodenum in tuberculosis
Authors: Kriplani A K , Kumar S , Sharma L K 
Published: December 2008

Summary
Extrinsic compression by tuberculous mesenteric nodes is the rarest form of duodenal obstruction and one such case is presented. Radiology is helpful in differentiating various duodenal lesions. Ideal surgical treatment is duodeno-jejunostomy but in some cases only gastroenterostomy is possible.
Dental infection as the cause of pyrexia of unknown origin—two case reports
Authors: Samra Y , Barak S , Shaked Y 
Published: December 2008

Summary
Two cases of pyrexia of unknown origin are described in which no cause was found despite exhaustive inpatient investigation until occult dental infection was detected: extraction of the teeth involved was followed by resolution of the pyrexia. Dental infection should be considered as an unusual but eminently treatable cause of pyrexia of unknown origin.
Granular cell tumour of the common bile duct
Authors: Cheslyn-Curtis S , Russell R C G , Rode J , Dhillon A P 
Published: December 2008

Summary
Granular cell tumors are a rare cause of benign biliary stricture. A case is reported which is unusual in that the diagnosis was made before the onset of jaundice. We emphasize the importance of accurate histology of biliary strictures, to eliminate confusion between those of benign and malignant nature and to ensure that the appropriate management is undertaken. Immunohistochemical evidence for the neural origin of this rare tumour is presented.
The sensation of facial swelling in temporal arteritis: a predictor for the development of visual disturbance
Authors: Friedman G , Friedman B 
Published: December 2008

Summary
The sensation of facial swelling in temporal arteritis may be an important predictor of the development of visual disturbance. A clinical report of two patients who developed a sensation of puffiness of the face without altered facial appearance, as a presenting symptom of temporal arteritis with visual disturbance is presented. This symptom, though documented previously by us, has not been identified before as a predictor of visual disturbance.
Destructive bone lesions in primary amyloidosis
Authors: Kramer M R , van Dijk J M , Hadas I , Hershko C 
Published: December 2008

Summary
We describe a patient with primary amyloidosis in whom multiple osteolytic lesions caused by amyloid bone tumours developed, and review the clinical features of the 18 cases with primary amyloidosis in whom destructive bone lesions have been reported. In contrast to amyloidosis associated with multiple myeloma, destructive lesions in the primary disease are mainly located to long bones; joint involvement is common, and radionuclide bone scan shows pronounced uptake of 99mTc-PP by the destructive bone lesions. Despite the superficial similarity between the destructive bone lesions associated with primary amyloidosis and multiple myeloma, distinction between these entities on clinical grounds is possible and may be easily confirmed by direct aspiration of the osteolytic infiltrates.
Multiple myelomatosis: an unusual cause of small bowel intussusception
Authors: Hill S A , Yudelman P L 
Published: December 2008

Summary
A 55 year old woman with multiple myeloma presented with a pathological fracture of the right neck of femur. Following internal fixation, and during subsequent radiotherapy, she developed small bowel obstruction. Laparotomy revealed an intussusception about a small bowel myeloma deposit. This is a previously unreported cause of small bowel intussusception.
Heart failure in sinus rhythm as the sole manifestation of Graves' disease
Authors: O'Malley B P , Northover B J , Woods K L 
Published: December 2008

Summary
A middle-aged man with Graves' disease presented with heart failure in sinus rhythm which preceded the more typical manifestations of the disease by some months. Once suspected, the diagnosis was supported by measurement of systolic time intervals, enabling the instigation of treatment in advance of biochemical confirmation.
Aluminium phosphide poisoning: a prospective study of 16 cases in one year
Authors: Chopra J S , Kalra O P , Malik V S , Sharma R , Chandna A 
Published: December 2008

Summary
Sixteen patients suffering from aluminium phosphide poisoning were treated during the year from January 1985 to December 1985. These accounted for approximately half the total number of cases of acute poisoning. Profuse vomiting, pain in the upper abdomen and shock were the most common presenting features. Six patients succumbed to their illness. Analysis of various prognostic factors revealed that ingestion of ‘unexposed’ tablets of aluminium phosphide taken from a freshly opened bottle was associated with a greater risk of fatal outcome. Aluminium phosphide poisoning has become an important matter of public health in parts of India.