bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of anticardiolipin antibodies in the elderly British population
Authors: Chakravarty K K , Gray R E , Webley M , Byron M A , Wozniak J 
Published: December 2008

Summary
In a cross-sectional study of 100 healthy elderly individuals, anticardiolipin antibodies (aCL) were measured using an ELISA technique. aCL were not detected in the majority of subjects (63%), and in the remaining 37% titres were within the laboratory reference range (mean +5 standard deviations) previously determined for adults of all ages. In contrast, significant titres of IgM rheumatoid factor were found in 10%, antimitochondrial antibody in 13%, antinuclear factor in 5%, anti-smooth muscle antibody in 18%, antiparietal cell antibody in 10%, and antireticulin antibody in 1%. Antibodies to single or double-stranded DNA were not detected in any subject.
We conclude that, although other auto-antibodies may be present in the healthy aging population in Britain, abnormally elevated levels of aCL antibody do not occur, and when present may be an indicator of autoimmune-mediated pathology.
Surgical palliation for pancreatic carcinoma
Authors: Zamboni W A , Fisher K S , Ross D S 
Published: December 2008

Summary
A review of 122 patients treated for pancreatic adenocarcinoma from January 1978 through December 1984 was accomplished to determine patient survival and the effect of surgical palliation. One hundred patients underwent laparotomy, including biopsy only (n = 42), biliary bypass (n = 30), gastric bypass (n = 1), biliary and gastric bypass (n = 14), and curative resection (n = 13). Total patient median survival was 3.6 months and no patient lived 5 years. No significant difference in survival was found between the biliary bypass and combined biliary-gastric bypass groups. Only 1 of 30 patients (3.3%) undergoing biliary bypass alone without evidence of pre-operative gastric outlet obstruction developed late gastric outlet obstruction requiring gastrojejunostomy. Operative time and postoperative morbidity were greater in the biliary-gastric bypass group. These results do not support routine prophylactic use of gastrojejunostomy at the time of biliary bypass for patients with unresectable carcinoma of the pancreas.
Guillain-Barré syndrome associated with rubella
Authors: Atkins M C , Esmonde T F G 
Published: December 2008

Summary
A 34 year old male patient with Guillain-Barré syndrome following rubella is described. Diagnosis of the infection was made by the detection of specific IgM and IgG antibody. This is a rare association and has not been previously reported in an adult without a characteristic rash.
Intravenous gammaglobulin therapy in the thrombocytopenia of haemorrhagic varicella
Authors: Large D M , Basu A , O'Brien H 
Published: December 2008

Summary
We report the case of a teenage boy with thrombocytopenia complicating varicella infection, which responded promptly to treatment with intravenous immunoglobulin therapy. Such treatment is well recognized in the management of immune thrombocytopenia, particularly where steroids are contra-indicated, but we have not found any previous case reports of the use of immunoglobulin in this condition.
Addison's disease, hypertension, renal and hepatic microthrombosis in ‘primary’ antiphospholipid syndrome
Authors: Inam S , Sidki K , al-Marshedy A R , Judzewitsch R 
Published: December 2008

Summary
We describe a 14 year old boy with antiphospholipid syndrome who initially presented at the age of 10 with recurrent loin pain, fever, weight loss, leucocytosis, thrombocytopenia, hypertension and haematuria. He had primary adrenal insufficiency with bilaterally enlarged adrenals on computed tomographic (CT) scan consistent with adrenal infarction. Renal and liver biopsies showed microthrombi in the glomerular capillaries and hepatic sinusoids respectively. The case is unusual in that hypertension rather than hypotension was dominant and a CT scan was consistent with bilateral adrenal infarction without haemorrhage. He represented with evidence of persistent hypertension with glomerulosclerosis and glomerular microthrombi on repeat renal biopsy. He continues to have permanent adrenal insufficiency with complete atrophy of his adrenals.
Granulomatous enteropathy in common variable immunodeficiency: a cause of chronic diarrhoea
Authors: Mike N , Hansel T T , Newman J , Asquith P 
Published: December 2008

Summary
Gastrointestinal disease is a well recognized feature in patients with common variable immunodeficiency, and is often due to infection with a variety of organisms. Symptoms usually improve with appropriate antibiotic therapy and replacement gammaglobulin. We describe three middle-aged female patients with common variable immunodeficiency who had protracted diarrhoea and weight loss. Despite extensive investigation no infectious cause was found.
All patients had granulomas distributed throughout the gastrointestinal tract, but no features of inflammatory bowel disease. There was a poor response to gammaglobulin replacement therapy, antibiotics or symptomatic treatment. We suggest that granulomatous enteropathy is another gastrointestinal manifestation of common variable immunodeficiency.
Low dose danazol in the treatment of the premenstrual syndrome
Authors: Deeny M , Hawthorn R , Hart D McKay 
Published: December 2008

Summary
This double-blind, randomized, crossover study compared the efficacy and safety of danazol (100 mg twice daily) with matching placebo in the treatment of severe premenstrual syndrome. Nineteen patients were randomly allocated to receive danazol for 3 months followed by placebo, and 18 to receive treatment in the reverse order.
Assessments of overall condition showed improvement to be statistically significantly more likely with danazol than with placebo (P&lt;0.001) after 3 months' treatment. Furthermore, daily visual analogue scale assessments demonstrated statistically significantly better premenstrual scores with danazol in comparison to placebo for breast discomfort, irritability, depression, anxiety, mood swings, crying, depressed libido and abdominal swelling.
It is concluded that danazol provides effective and generally well tolerated treatment for severe premenstrual syndrome.
Giant thymic carcinoid
Authors: John L C H , Hornick P , Lang S , Wallis J , Edmondson S J 
Published: December 2008

Summary
Thymic carcinoid is a rare tumour. It may present with ectopic endocrine secretion or with symptoms of compression as a result of its size. A case is reported which presented with symptoms of compression where the size of the tumour was uniquely large such as to warrant the term giant thymic carcinoid. The typical histological features are described, together with its possible origin and its likely prognosis.
Atrial septal defect presenting as recurrent primary amoebic lung abscess
Authors: Sharma M , Mehta H , Sharma S K 
Published: December 2008

Summary
A middle-aged female with an atrial septal defect (secundum type) presented with a primary pulmonary amoebic abscess. She was successfully treated with antiamoebic therapy. One year later she presented with a similar lung abscess which again responded to antiamboebic treatment. Attention is drawn to the fact that a patient with a left to right shunt can present with a recurrent rare primary parasitic infection of the lung.
Massive gastrointestinal haemorrhage associated with ileal lymphoid hyperplasia in Gaucher's disease
Authors: Jones D R , Hoffman J , Downie R , Haqqani M 
Published: December 2008

Summary
A case report of adult type I Gaucher's disease is described, with profound terminal ileal haemorrhage in association with ileal lymphoid hyperplasia. Peroperative ileal endoscopy localized the segment involved allowing an appropriate resection and successful outcome for the patient.
Localized primary sclerosing cholangitis mimicking a cholecystectomy stricture relieved by an endoprosthesis
Authors: Oren R , Goldin E , Harats N , Libson E , Shouval D 
Published: December 2008

Summary
Primary sclerosing cholangitis presenting as a localized stricture affecting a segment of the extrahepatic biliary tree is rarely found. We describe the case of a 39 year old woman with obstructive jaundice, in whom this diagnosis was proven by endoscopic retrograde cholangiography. An endoprosthesis was endoscopically introduced through the stenotic area which led to a dramatic improvement enabling a successful liver transplantation after 2 years.
The successful surgical repair of a ruptured interventricular septum following a myocardial infarct in an 89 year old man
Authors: Grocott-Mason R M , Yates A , Wray R 
Published: December 2008

Summary
This case report describes the successful repair of an acquired ventricular septal defect following an anterior full thickness myocardial infarct in an 89 year old man. Four months after the infarct the patient was in severe congestive cardiac failure (NYHA Class IV), despite medical treatment, with signs of a ventricular septal defect. This was confirmed by echodoppler and cardiac catheterization. Surgical repair of the ventricular septal defect was performed. He made an uncomplicated recovery and two and a half years later is well and active. We believe he is the oldest patient who has had this operation successfully.
Crescentic transformation in primary membranous glomerulonephritis
Authors: Kwan J T C , Moore R H , Dodd S M , Cunningham J 
Published: December 2008

Summary
A 31 year old man first developed steroid-resistant idiopathic membranous glomerulonephritis in 1981. Stable normal renal function was maintained until August 1988 when he suffered a clinical relapse with heavy proteinuria and declining renal function. Immunosuppressive therapy with prednisolone and cyclophosphamide was instituted in an attempt to arrest this relapse. Despite this, he later developed acute renal failure with histological evidence of crescentic transformation of his nephritis. This unusual transformation was not associated with features of systemic vasculitis or positive anti-glomerular basement membrane and anti-neutrophil cytoplasmic antibodies.
Permanent pacemakers in nonagenarians
Authors: Elizabeth J E , Green G J 
Published: December 2008

Summary
We report our experience of 20 patients who have had permanent pacemakers implanted for the first time after the age of 90. The main indications were syncope or presyncope which occurred in 15 patients. Complete heart block was present in 14 patients. Syncopal and presyncopal symptoms were cured in 73%. Nonagenarians paced for complete heart block can expect to survive for as long as others of the same age without heart block. Permanent pacing is an effective and appropriate treatment in the very old.
Diverticulum of a Meckel's diverticulum containing a stone
Authors: Gibney E J 
Published: December 2008

Summary
An 18 year old girl presented with acute abdominal pain and a calcified opacity in the pelvis. She proved to have a Meckel's diverticulum which had a secondary diverticulum at its apex, containing a stone. Meckel's stones are uncommon and diverticula of a Meckel's diverticulum exceedingly rare. This is only the second recorded case of such a diverticulum containing a stone, and the first to describe a calcified stone in this location.
T cell dominated inflammatory reactions in the bronchioles of asymptomatic asthmatics are also present in the nasal mucosa
Authors: Poulter L W , Norris A , Power C , Condez A , Burnes H , Schmekel B , Burke C 
Published: December 2008

SummaryEndobronchial and nasal mucosa biopsies were obtained from 5 patients with clinically-stable, diagnosed asthma (ATS criteria). A comparison was made of the presence and distribution of immunocompetent lymphocytes and macrophages within each sample. The distribution of immunocompetent cells within the nasal biopsies of the asthmatic patients reflected a very similar inflammatory infiltrate to that seen in the bronchial biopsies. Significantly raised numbers of T lymphocytes, CD45RO + lymphocytes, RFD1 + macrophage-like cells and RFD7 + macrophages were seen in both the nasal mucosa and the bronchial biopsies. Increases in HLA-DR expression were also seen in the nasal mucosa biopsies from asthmatics although the increases over normal did not reach statistical significance. It is concluded that inflammation present in the nasal mucosa of asymptomatic asthmatics exhibits cellular characteristics also seen in endobronchial biopsies. This observation offers the possibility that mucosal biopsy may be an alternative and less invasive approach for studying the cells involved in the bronchial inflammatory reaction that possibly predisposes asthmatics to bronchial hyper-responsiveness.
Small bowel function after aortic surgery
Authors: Barker S G E , Dodds R D A , Middlemiss A , Bennett C E , Russell M H , Sellick B C , Thomas M H 
Published: December 2008

Summary
One cause of post-operative morbidity in the elective repair of abdominal aortic aneurysms is the development of a paralytic or ‘adynamic’ ileus. In a series of 20 consecutive patients undergoing such a procedure, the maintenance of small bowel motility and absorptive capacity in the immediate post-operative period was assessed using barium sulphate and xylose passed down a naso-duodenal tube sited at the time of surgery. This simple study demonstrated that small bowel function was preserved in all cases, and hence that patients could be fed enterally via naso-duodenal tube (in particular using very low residue formulae) rather than using costly parenteral regimens, should an ileus persist.
Melioidosis in a patient from Bangladesh
Authors: Kibbler C C , Roberts C M , Ridgway G L , Spiro S G 
Published: December 2008

Summary
A 54 year old Bangladeshi man presented with a history and chest X-ray appearances suggestive of pulmonary tuberculosis. Following deterioration 4 weeks later, he required ventilation. Although a blood culture isolate was subsequently found to be Pseudomonas pseudomallei, it was initially misidentified and dismissed as a contaminant. Further cultures demonstrated the organism, but the patient died, despite treatment with ceftazidime.
The case illustrates the importance of taking a detailed travel history and having a high index of suspicion in patients from South East Asia and the Indian sub-continent, including Bangladesh, where the disease has not previously been considered endemic.
Alcohol and Indian porphyrics
Authors: Saksena H C , Panwar R B , Rajvanshi P , Sabir M , Suri M 
Published: December 2008

Summary
The role of alcohol as the precipitating factor in the induction of acute attacks of acute intermittent porphyria was studied in an Indian population. Thirty-four teetotal patients with acute intermittent porphyria, in remission, were given 60 ml of 30% ethanol. Except for two patients, all had negative Watson-Schwartz tests prior to the alcohol. Within 24 hours, the Watson-Schwartz test became positive in 16 of these 32 patients (50%). In 8 out of the 34 patients (23.5%) a clinical attack was precipitated, including both patients who had a positive Watson-Schwartz test prior to the alcohol.
It was concluded that alcohol does precipitate an acute attack in a significant percentage of patients of Indian origin with acute intermittent porphyria. Patients already excreting porphobilinogen are at a greater risk of developing an acute attack on alcohol ingestion. This study is the first from India and probably first of its kind to be reported from any country.
Three cases of alpha-1-antitrypsin deficiency in the elderly
Authors: Jack C I A , Evans C C 
Published: December 2008

Summary
We report three elderly patients who presented with increasing dyspnoea on exertion and radiological evidence of basal bullous emphysema. On further investigation they were found to have alpha-1-antitrypsin deficiency.
We emphasize that alpha-1-antitrypsin deficiency can present much later than is usually the case especially if the patient is a life-long non-smoker.
The practice of rectal examination
Authors: Ng D P K , Mayberry J F , McIntyre A S , Long R G 
Published: December 2008

Summary
Rectal (both digital and rigid sigmoidoscopic) examination is an important part of the clinical examination. The aim of this study was to find out the opinions of the patients to this routine examination at the time of referral by their general practitioner and during their first hospital interview. Assessment of the value for the rectal examination was also examined.
We questioned 103 patients attending their second out-patient interview through a simple questionnaire. We discovered that patients considered awareness and explanation important: patients preferred to be told of the possibility of rectal examination prior to hospital consultation. Explanation of the method and reason was expected from hospital doctors. Formal consent was expected; informed verbal consent should be sufficient. Where logistically possible, a chaperone should always be present. Rectal examination would have facilitated the diagnosis in 47% of the patients examined. Thus, rectal examination should be performed on all patients where symptoms are referable to the lower gastrointestinal tract and where a possible diagnosis may be made or facilitated.
Rapid onset of blindness due to meningeal carcinomatosis from an oesophageal adenocarcinoma
Authors: Teare J P , Whitehead M , Rake M O , Coker R J 
Published: December 2008

Summary
We report a 49 year old man who presented with left leg weakness, frontal headache, impaired concentration and dysphagia. He was thought to have a benign oesophageal stricture on barium swallow and oesophagoscopy though this was not initially biopsied. During admission his vision deteriorated so that he could only recognize bright light. Repeat oesophagoscopy demonstrated an oesophageal adenocarcinoma. The diagnosis of meningeal carcinomatosis was confirmed at post-mortem.
Sudden bilateral blindness is a common feature of meningeal carcinomatosis but, as this is rare, it is not commonly considered in the differential diagnosis of visual loss. The visual loss can be explained by vascular insufficiency in association with tumour cuffing of the subarachnoid space of the optic nerve sheath, by neuronal toxins, or other, as yet unknown, mechanisms.
Bickerstaff's brainstem encephalitis associated with typhoid fever
Authors: Wali G M 
Published: December 2008

Summary
A 14 year old boy developed the syndrome of Bickerstaff's brainstem encephalitis during the course of bacteriologically proved typhoid fever. The clinical course and the results of various neurological investigations are detailed. This report adds a further manifestation to the published neuropsychiatric complications of typhoid fever.
Coeliac disease presenting with cerebellar degeneration
Authors: Hermaszewski R A , Rigby S , Dalgleish A G 
Published: December 2008

Summary
A case of rapidly progressive cerebellar degeneration with bilateral sixth nerve palsies is described in whom investigation revealed the presence of unsuspected coeliac disease. In spite of treatment with a gluten free diet, rapid fatal deterioration occurred. Coeliac disease should be considered in patients with encephalopathy of obscure origin.
The clinical features of late onset anorexia nervosa
Authors: Joughin N A , Crisp A H , Gowers S G , Bhat A V 
Published: December 2008

Summary
This study examines clinical features of late onset anorexia nervosa. This involved the scrutiny of a large database of patients with anorexia nervosa comprising data gathered at standardized initial assessments over the period 1960–1990. Patients with a late onset were compared to other selected patient samples.
The population comprised 12 patients with a first onset of anorexia nervosa at or after the age of 30, 415 patients with an onset after 15 but before 20 and 9 patients with an onset after 15 but before 20 and matched for age at presentation with the late onset group.
Features studied included age at menarche, age at onset of anorexia nervosa, age at presentation, duration of illness, weight at presentation, lowest adult weight, highest weight, weight at onset of illness, marital status and parity.
Patients with an onset of anorexia nervosa after the age 30 comprised 2% of the total female patient sample. Though such patients were rare, their clinical features were very similar to those of typical patients with adolescent onset. Notably, young and late onset patients had similar durations of illness prior to presentation, and similar proportions had bulimia and defensive vomiting. Feared sexuality, no longer necessary for childbearing, emerged as being of apparent aetiological significance in the late onset group, with the disorder embodying its rejection, as often also seems to be the case with earlier onset. The late onset cases were hard to diagnose and had a poor outcome.
The study underlines the importance of considering the diagnosis of anorexia nervosa in older patients, even if there is no earlier history of anorexia nervosa. Such patients are likely to find it easier to conceal the psychological origins of their problem behind the possibility of a primary physical illness, or behind psychiatric diagnoses such as depression, the treatment of which may not threaten their avoidance of normal body weight.
Pneumoperitoneum without peritonitis
Authors: Daly B D , Guthrie J A , Couse N F 
Published: December 2008

SummaryWe present our experience with 5 patients, all of whom were noted to have radiological signs of pneumoperitoneum in the absence of clinical features of peritonitis. All 5 cases were eventually shown to be due to causes not requiring surgery. We review the numerous unusual causes of pneumoperitoneum which do not require urgent surgical intervention and emphasize their importance in cases where the absence of signs of peritonitis may cause diagnostic difficulty.
Lipoprotein lipase deficiency due to long-term heparinization presenting as severe hypertriglyceridaemia in pregnancy
Authors: Watts G F , Cameron J , Henderson A , Richmond W 
Published: December 2008

Summary
A case of severe hypertriglyceridaemia presenting in the third trimester of pregnancy in a woman on long-term heparin prophylaxis is described. The hypertriglyceridaemia was attributed to impaired clearance of triglyceride-rich lipoprotein particles secondary to heparin-induced reduction in the activity of the lipolytic enzyme, lipoprotein lipase.
Fatal fulminant hepatic failure in a 'solvent abuser'
Authors: McIntyre A S , Long R G 
Published: December 2008

SummaryThe case of a 17 year old abuser of butane aerosols who developed fulminant hepatic failure after taking a proprietary engine or carburetor cleaner is described. Fatalities as a result of liver failure due to volatile hydrocarbons or solvents have not previously been reported. The likely toxins included isopropyl alcohol, methyl amyl alcohol, butylated hydroxytoluene as well as petroleum products, and evidence for their toxicity is reviewed. The possibility of increased susceptibility to hepatotoxins after enzyme induction by abuse of volatile agents is discussed. Hepatic dysfunction should be sought in patients who abuse solvents or volatile hydrocarbons and supportive measures instituted promptly when required.
Organ limited amyloidosis with lymphadenopathy
Authors: Dalton H R , Featherstone T , Athanasou N 
Published: December 2008

Summary
Hilar and mediastinal lymphadenopathy associated with localized pulmonary amyloid is very rare. We describe two cases of this unusual combination, one of endobronchial amyloid with adenopathy and the other of nodular parenchymal amyloid with hilar nodes. In both these cases the nodes contained calcification, and in the nodular parenchymal case in particular, this appearance is highly suggestive of pulmonary amyloid.