bluuebunny/crossref_metadata_2025_split huggingface dataset:
Successful late treatment of venous air embolism with hyperbaric oxygen
Authors: Dunbar E M , Fox R , Watson B , Akrill P 
Published: December 2008

Summary
A case of haemodialysis-associated venous air embolism is described. The patient commenced hyperbaric oxygen therapy 21 hours after the event when, despite appearing decerebrate, he made a complete recovery. This case underlines the importance of all clinicians being aware of those centres with facilities for hyperbaric therapy and the need to refer all patients with cerebral air embolism even following a prolonged delay.
Primary plasmacytoma of the thyroid
Authors: Chesyln-Curtis S , Akosa A B 
Published: December 2008

Summary
Primary plasmacytoma of the thyroid is a very rare tumour. We report a case and emphasize the importance of excluding multiple myeloma which may present as an extramedullary plasmacytoma. Histological diagnosis has been simplified by the use of immunohistochemical techniques.
Myalgic encephalomyelitis—a persistent enteroviral infection?
Authors: Dowsett E G , Ramsay A M , McCartney R A , Bell E J 
Published: December 2008

Summary
Myalgic encephalomyelitis is a common disability but frequently misinterpreted. Amongst 6,000 patients referred for general microbiological diagnosis between 1975 and 1987, 420 cases were recognized. Coxsackie B neutralization tests, in 205 of these, demonstrated significant titres in 103/205 (50%), while of 124 additionally investigated for enteroviral IgM, 38/124 (31%) were positive. This illness is distinguished from a variety of other post-viral states by an unique clinical and epidemiological pattern characteristic of enteroviral infection. Prompt recognition and advice to avoid over-exertion is mandatory. Routine diagnosis, specific therapy and prevention, await further technical advances.
Lornoxicam, indomethacin and placebo: comparison of effects on faecal blood loss and upper gastrointestinal endoscopic appearances in healthy men
Authors: Warrington S J , Debbas N M , Farthing M , Horton M , Johnston A , Thillainayagam A , Turner P , Ferber H 
Published: December 2008

Summary
Forty-five healthy men aged 21–34 years took part in a double-blind, parallel-group, placebo-controlled study of the effects of 28 days' treatment with lornoxicam 4 mg twice daily or indomethacin 50 mg twice daily on faecal blood loss and the endoscopic appearances of gastric and duodenal mucosa. After an initial endoscopic examination, subjects received, intravenously, on day 0, autologous erythrocytes labelled with 51Cr. Complete daily faecal collections were then made from days 6–12, 20–26 and 34–40. The drug treatments or placebo were given from days 13–41. Faecal blood loss was calculated from 51Cr-specific activity of blood and faeces. Endoscopy was repeated 4–8 hours after the last dose of medication; mucosal appearance was graded on a 5-point scale.
Lornoxicam caused no more adverse events than placebo; indomethacin caused more indigestion and central nervous system effects, and one subject in this group was withdrawn from the study. Median total blood losses during the pre-treatment and the second and fourth weeks of treatment were respectively 3.33, 3.95 and 5.71 ml for lornoxicam, 2.87, 7.04 and 7.75 ml for indomethacin, and 4.55, 3.64 and 4.13 ml for placebo. Differences between treatments were not statistically significant (P = 0.081 for second week of treatment, P = 0.383 for fourth week of treatment; Kruskal-Wallis test).
The effect of chlortenoxicam on faecal blood loss in this study was thus intermediate between placebo and indomethacin, but within- and between-subject variability was such that the differences were not statistically significant. Endoscopic findings were normal in most subjects before and after all treatments, but indomethacin was associated with a slightly greater deterioration in endoscopic score and was the only treatment associated with Grade 3 appearance (in a single patient) in post-treatment endoscopy.
Pulmonary infiltrates and fever induced by isoniazid
Authors: Salomaa E R , Ruokonen E-L , Tevola K , Tala E 
Published: December 2008

Summary
An 88 year old woman with bacteriologically confirmed pulmonary tuberculosis was first treated with isoniazid, rifampicin and pyrazinamide. Two weeks later she developed pulmonary infiltrates with fever. A drug-induced reaction was suspected but the reaction recurred three times until isoniazid was identified as the cause. The reaction became worse each time, finally being nearly fatal.
Specialized gastrointestinal units for the management of upper gastrointestinal haemorrhage
Authors: Sanderson J D , Taylor R F , Pugh S , Vicary F R 
Published: December 2008

Summary
In 1986, 292 patients were admitted to a joint medical-surgical gastrointestinal unit with upper gastrointestinal haemorrhage. Fourteen patients died (4.8%) a mortality considerably lower than recorded in most series. The low mortality may result from the use of a specialized gastrointestinal unit to which all patients with upper gastrointestinal haemorrhage are admitted and managed with strict protocols for resuscitation, transfusion and surgery.
Chronic bronchial suppuration and antineutrophil cytoplasmic antibody (ANCA) positive systemic vasculitis
Authors: Sitara D , Hoffbrand B I 
Published: December 2008

Summary
Two patients with long-standing chronic bronchial suppuration developed antineutrophil cytoplasmic antibody (ANCA) positive Wegener's granulomatosis and microscopic polyarteritis respectively. There is published evidence of an association between previous suppurative respiratory disease and Wegener's granulomatosis. We believe that our cases provide further evidence that chronic lung infection may play an aetiological role in the development of ANCA-positive systemic necrotizing vasculitis in some individuals.
Primary non-Hodgkin's lymphoma of liver with humoral hypercalcaemia
Authors: Santhosh-Kumar C R , Ajarim D S , Shipkey F D 
Published: December 2008

Summary
A case of primary non-Hodgkin's lymphoma of the liver with associated humoral hypercalcaemia is described. The patient was successfully treated with combination chemotherapy. A similar association has not been reported previously.
Gastric antral vascular ectasia (watermelon stomach)—therapeutic options
Authors: Park R H R , Danesh B J Z , Upadhyay R , Howatson A G , Lee F D , Russell R I 
Published: December 2008

Summary
We have encountered five cases of chronic iron deficiency anaemia due to bleeding from gastric antral vascular ectasia (watermelon stomach). Two cases were associated with a lymphoma and in three cases there was evidence of portal hypertension. Two patients were treated conservatively by blood transfusions. The other patients required either surgery or tranexamic acid or endoscopic laser therapy to control the chronic haemorrhage.
Mitral valve prolapse and occult aortic coarctation
Authors: Ludman P , Yacoub M , Dancy M 
Published: December 2008

SummaryA 22 year old man developed symptoms of left ventricular failure secondary to atrial fibrillation and congenital mitral regurgitation. After operation for mitral valve repair he was unable to be successfully weaned from cardiopulmonary bypass and this was ascribed to poor left ventricular function. He therefore underwent emergency cardiac transplantation but again was unable to be weaned from bypass. At post-mortem examination a previously undiagnosed aortic coarctation was revealed.The presentation of occult aortic coarctation is discussed, and its association with congenital mitral valve abnormalities reviewed.
Small bowel obstruction with multiple perforations due to enterolith (bezoar) formed without gastrointestinal pathology
Authors: Salim A S 
Published: December 2008

Summary
An enterolith (bezoar) usually originates in an intestinal diverticulum or in a segment of bowel loculated by stricture formation. Stasis promotes its formation. This communication describes a case in which a large enterolith caused obstruction and multiple perforations of the terminal ileum in the absence of any predisposing gastrointestinal pathology. The management of this rare occurrence is discussed and the literature reviewed.
Immobilization-related hypercalcaemia—a possible novel mechanism and response to pamidronate
Authors: Gallacher S J , Ralston S H , Dryburgh F J , Logue F C , Allam B F , Boyce B F , Boyle I T 
Published: December 2008

Summary
Immobilization-related hypercalcaemia is an uncommon but important condition being associated not infrequently with both urolithiasis and osteoporosis. In this study 5 patients who had been immobilized for a mean of 3 months and had a mean adjusted serum calcium of 3.15 mmol/l were treated with doses of intravenous pamidronate ranging between 10 mg and 45 mg. All patients became normocalcaemic by day 3. Patients 1–3 mobilized shortly after treatment and remained normocalcaemic. In those patients who continued to be immobile hypercalcaemia recurred after an interval of several weeks. Retreatment with pamidronate again resulted in normocalcaemia. No side effects were noted with treatment.
All of the patients studied had increased rates of bone resorption as shown by elevated urinary hydroxyproline/creatinine ratios (median:range) of 0.101:0.045–0.180 (normal &lt; 0.033) and elevated calcium/creatinine ratios of 2.50:0.69–3.63 (normal &lt; 0.50).
None of the patients in this study had any of the usual risk factors for developing immobilization-related hypercalcaemia though all 5 patients had problems with significant sepsis which we postulate may have lead to cytokine release which in turn contributed to the development of hypercalcaemia.
We conclude that pamidronate (at doses as low as 10 mg) is safe and effective in immobilization-related hypercalcaemia and suggest that sepsis should be added to the list of risk factors for development of this syndrome.
Superadded aspergillosis on carcinoid bronchial adenoma leading to delayed diagnosis
Authors: Kumar L , Singh M , Mitra S K , Bannerjee C K 
Published: December 2008

Summary
A review of aspergillosis in neoplastic disease revealed that most cases occur in association with malignant disorders. Amongst solid tumours it is mostly adenocarcinomas which are invaded by the fungus due to necrotic cavity formation. We here record the first reported association of aspergillosis with a benign carcinoid bronchial adenoma which was hidden by the fungal growth with a delay in diagnosis.
Nemaline myopathy: a report of two siblings as evidence of autosomal recessive inheritance of the infantile type
Authors: Cartwright J D , Castle D J , Duffield M G , Reef I 
Published: December 2008

Summary
We report two opposite-sex siblings with the severe infantile form of nemaline myopathy; diagnoses were made on muscle biopsy. Neither parent showed clinical or electromyographic evidence of myopathy, and both had negative muscle biopsies. Autosomal recessive inheritance seems likely.
Spontaneous rupture of a splenotic nodule
Authors: Lanigan D J 
Published: December 2008

Summary
A case is presented of spontaneous rupture of splenic tissue occurring 14 years after a splenectomy was carried out for trauma. Spontaneous rupture of a splenotic nodule has not previously been described and it may be added to the list of causes of spontaneous haemoperitoneum. The incidence and function of residual splenic tissue are briefly discussed and other causes of splenic rupture are outlined.
Poor response of breast cancer to tamoxifen
Authors: McDonald P J , Carpenter R , Royle G T , Taylor I 
Published: December 2008

Summary
Fifty eight (58) patients with early breast cancer (mean age 78.3 years) and 37 patients with advanced breast cancer (mean age 65.9 years) were treated with tamoxifen orally 20 mg daily or twice daily. The mean follow-up time was 19.1 months in the early group and 18.4 months in the late group. The drug was extremely well tolerated. All patients had cytological or histological evidence of breast cancer. A complete or partial response was found in only 36% of the patients with early breast cancer and only 13% in the advanced group. We conclude that tamoxifen was disappointing as a primary therapy in our patients. Although because of its lack of toxicity it can be seen as initial therapy for patients with breast cancer, it may have to be supplanted rapidly by other forms of therapy in the substantial proportion of patients in whom a response will not occur.
Ethnic minorities, health provision and the 1976 Race Relations Act
Authors: Bedi R , MacEwen M 
Published: December 2008

Summary
The present anti-racial discrimination legislation in the United Kingdom is embodied in the 1976 Race Relations Act. In essence this Act attempts to avoid any form of direct or indirect discrimination on the basis of racial or ethnic origin. However, health professionals are acutely aware that there are important racial differences in disease, some of which are, in fact, not racial but merely associated with social deprivation, poor housing and, of course, the incapacity to speak English.
These new findings present the medical profession, in the climate of scarce resources, with the challenge of meeting these needs without discriminating in favour of, or against, individuals on the basis of their race. This is because there are few provision in the 1976 Act to allow for such discrimination, even when it is for an ethnic group's advantage. The dilemmas this raises for health professionals who are involved in planning services for ethnic minorities are discussed.
Capgras' syndrome with organic disorders
Authors: Collins M N , Hawthorne M E , Gribbin N , Jacobson R 
Published: December 2008

Summary
Capgras' syndrome, one form of the delusional misidentification syndromes, is described. Three patients with the syndrome are reported. The first had a right cerebral infarction, the second had nephrotic syndrome secondary to severe pre-eclampsia in the puerperium, and the third had uncontrolled diabetes mellitus with dementia. Evidence is reviewed regarding an organic aetiology for Capgras' syndrome. We conclude that, when the syndrome is present, a thorough search for organic disorder should be made.
Acute myocardial infarction in sickle cell anaemia associated with severe hypoxia
Authors: Saad S T O , Arruda V R , Junqueira O O M D , Schelini F A , Coelho O B 
Published: December 2008

Summary
A 17 year old boy with sickle cell anaemia presented with acute myocardial infarction associated with severe hypoxia and reticulocytopenia. Ischaemic heart disease is rare in sickle cell anemia and in this case it is possible that the acute episode of hypoxia led to myocardial infarction.
Elevated human chorionic gonadotrophin levels in a patient with pancreatic carcinoma presenting with a testicular metastasis
Authors: Taylor H , Heaton N , Farrands P , Kirkham N , Fletcher M 
Published: December 2008

Summary
Elevated levels of human chorionic gonadotrophin are associated with primary testicular tumours and usually indicate the presence of trophoblastic elements. Human chorionic gonadotrophin can also be secreted by extragonadal tumours which may metastasize to the testes. A patient is described presenting with a testicular tumour secreting human chorionic gonadotrophin which later proved to be a metastasis from a pancreatic adenocarcinoma. Up to 70% of malignant pancreatic tumours can secrete human chorionic gonadotrophin.
Endoscopic drainage of a recurrent pancreatic pseudocyst
Authors: Grewal H P , London N J M , Carr-Locke D , Wood K F 
Published: December 2008

Summary
Pancreatic pseudocyst is a significant complication of both acute and chronic pancreatitis. Several methods of cyst drainage have been described. Endoscopic cystogastrostomy is a relatively new technique which is illustrated by the following case report, the first in the UK literature.
Solitary gastric hamartomatous polyp and upper gastrointestinal haemorrhage: an exceptional presentation of an unusual diagnosis
Authors: Erdozain J C , Sánchez-Ruano J J , San Román A L , Boixeda D , Moreira V F , Plaza A G 
Published: December 2008

Summary
A case of solitary gastric hamartomatous polyp, presenting as upper gastrointestinal haemorrhage, is reported. Both the entity itself, and the clinical presentation, are exceptional. The significance of the solitary gastric hamartomatous polyp and implications of its diagnosis are discussed.
Acrocyanosis in anorexia nervosa
Authors: Bhanji S , Mattingly D 
Published: December 2008

Summary
Acrocyanosis, an uncommon disorder of the peripheral circulation, may occur in patients with anorexia nervosa. It is not known why this should be, nor whether acrocyanosis correlates with any other features of the disorder. The findings in an unselected series of 155 anorectics are reported. Acrocyanosis occurred in 32 and was more prevalent among the more severely ill. It was associated also with pallor of the face and trunk, slower pulse rates and higher fasting plasma glucose levels. Acrocyanosis could represent a more extreme form of a heat conserving mechanism not uncommon in anorectics. The possible relationship between peripheral vascular changes and plasma glucose levels requires further study.
A new breast screening programme–an audit of the first year
Authors: Kirby R M , Williams M , Hopper G , Skinner M D , French C , Suarez V , Summerly M E , Gray J G 
Published: December 2008

Summary
The experience of a new breast screening unit is reported. In the first 12 months there was a 72.1% response rate with 9890 women being screened. After the initial screen 598 (5.8%) were referred to the Assessment clinic. Following repeated mammography and clinical examination 166 patients were referred for a surgical opinion; 105 (1.06% of the total screened) were considered to be possibly malignant; 61 further patients with clinical and mammographically benign disease were kept under review by a single surgeon; 101 patients had excision biopsies; 28 of 32 palpable breast lumps and 36 of 69 non-palpable lesions proved to be malignant.
Myoclonus: a manifestation of neurocysticercosis
Authors: Puri V , Chowdhury V , Gulati P 
Published: December 2008

Summary
A case of neurocysticercosis in an 11 year old female manifesting only as myoclonic seizures is reported. The diagnosis was based upon ELISA test, computed tomography, and biopsy of a subcutaneous nodule. The patient responded to anticysticerci drug treatment.
Neurocysticercosis has not to our knowledge been previously reported to have presented with myoclonus.
Plasma exchange in the treatment of Guillain-Barré syndrome: experience in a sub-regional referral centre
Authors: Anderson N A B , Kyriakides T , Ferguson I T , Wallington T B 
Published: December 2008

Summary
Plasma exchange became popular in the treatment of Guillain-Barré syndrome with the publication in 1985 of results by the Guillain-Barré Study Group. Since then we have treated 24 patients referred for plasma exchange. We have audited their outcome and compared this with the results of patients in the treatment arm of the USA Study. Our patients were of comparable age and clinical severity and had similar duration of illness before starting plasma exchange. Nine of our patients required ventilation for a median of 24 days. The median time to improve one clinical grade was 19 days which compared well with the Study Group results. We have shown that plasma exchange may be safely performed in a district general hospital in a setting appropriate to the patient's clinical condition. We concur with the central conclusion of the Study, that if treatment is started early in the disease, the patient's outcome is improved.
Severe diabetic retinopathy at presentation in a young man
Authors: Morris G C , James R A , Powell R G , Jones M K 
Published: December 2008

Summary
A 22 year old man presented with a severe ischaemic diabetic retinopathy and, in spite of photocoagulation therapy, was blind in one eye 16 months after diagnosis. Four similar cases of aggressive diabetic retinopathy are reviewed. There is increasing evidence that a small group of young men with insulin dependent diabetes (IDD) may develop severe diabetic retinopathy at, or soon after, diagnosis.
Primary sclerosing cholangitis associated with systemic sclerosis
Authors: Fraile G , Rodríguez-García J L , Moreno A 
Published: December 2008

Summary
Primary sclerosing cholangitis is a chronic inflammatory fibrotic disorder strongly associated with inflammatory bowel disease. Although an association between some inflammatory fibrotic conditions, such as Riedel's thyroiditis and retroperitoneal fibrosis and primary sclerosing cholangitis has been described, to our knowledge there are no reports of primary sclerosing cholangitis in patients with systemic sclerosis.
A patient with this combination of conditions is presented and the possible significance of the association discussed.
Occult carcinoma in an adult choledochal cyst
Authors: Dowsett J F , Rode J , Chandiramani V A , Russell R C G 
Published: December 2008

Summary
The complications of choledochal cyst are avoidable if diagnosed early, and adequate resection undertaken. This case report describes the long history of right subcostal pain in a young man of 26 who had a squamous carcinoma in a choledochal cyst diagnosed after serial section of the excised cyst. Subsequent resection of the head of the pancreas showed histological residual tumour from which he died 4 months later. This case illustrates the need for complete early excision of a choledochal cyst to prevent this complication.
Biochemical effects of urapidil on red cell membrane ion transport systems in a population of elderly essential hypertensives
Authors: Antonicelli R , Balducci E , Lipponi G , Lucantoni C , Gaetti R , Paciaroni E 
Published: December 2008

Summary
The aim of our work was to verify the effect of urapidil on membrane ion transport systems. This was a randomized, double-blind, cross-over study which evaluated the clinical and biochemical effects of urapidil (30 mg twice daily in comparison with placebo) in a group of 10 elderly hypertensive patients (3 male, 7 female ranging from 68 to 90 years, mean age 79.2 ± 7.6 years). For the evaluation in fresh erythrocytes of principal ion transport systems (cotransport Na+/K+, countertransport Na+/Li+, Na+/K+ ATPase pump. intracellular Na+ and K+) we used the nystatin technique. We found that urapidil activated the red cell membrane ions cotransport system (basal values: 83.7 ± 50.3 mumol Na+ RBC 1−1.h−1, after 1 month of urapidil therapy: 181.5 ± 89.3 mumol Na+ RBC 1−1.h−1) (P &lt; 0.01), without significant changes in the other biochemical parameters evaluated.
Our data suggest that one of the mechanisms of the urapidil antihypertensive effect could involve an increase in the membrane sodium cotransport system.
Bilateral carotid aneurysms unmasked by severe hypopituitarism
Authors: Michils A , Balériaux D , Mockel J 
Published: December 2008

Summary
We describe a patient who initially presented with severe hyponatraemia and grand mal seizures, without any focal neurological symptoms. The final diagnosis was that of giant bilateral carotid aneurysms extending into the sella turcica with anterior hypopituitarism. To the best of our knowledge, this is the first case report of symmetrical carotid aneurysms manifested exclusively by an acute endocrine emergency with none of the concomitant usual focal signs such as headache, failing vision, oculomotor palsy or subarachnoid hemorrhage.
Dramatic oligoclonal paraproteinaemia following a pneumococcal septicaemia
Authors: Probert C S J , Roland J M , Simpson K R , Fairham S A 
Published: December 2008

Summary
We describe a case of paraproteinaemia in which there were high concentrations of four monoclonal bands shown on qualitative, and confirmed by quantitative, techniques. The disorder followed a pneumococcal infection and resolved spontaneously with the complete disappearance of all four bands.