bluuebunny/crossref_metadata_2025_split huggingface dataset:
Septum of the gallbladder, clinical implications and treatment
Authors: Deutsch A A , Englestein D , Cohen M , Kunichevsky M , Reiss R 
Published: December 2008

Summary
We report four patients with a congenital gallbladder septum whose symptoms resembled those of cholelithiasis, in one case giving rise to acute cholecystitis. Cholecystectomy relieved symptoms in all cases and examination of the operative specimen confirmed the clinical diagnosis and X-ray findings. Ultrasonography made a positive diagnosis in the last two cases and no stones were found in any of the cases described. Cholecystectomy is advocated in symptomatic patients with this condition, even when gallstones are not present.
Antibodies to the thyroid gland and to the thyrotrophin receptor in African and Indian thyrotoxic patients
Authors: Desai R K , Jialal I , Omar M A K , Rajput M C , Joubert S M 
Published: December 2008

Summary
Sixty two thyrotoxic patients, 34 African and 28 Indian, were studied in order to assess the prevalence of thyroid antibodies and TSH binding inhibitory activity (TBI): 45 had Graves' disease and 17 had toxic nodular goitres. Microsomal and thyroglobulin antibodies were positive more often in Indian than in African patients with Graves' disease (microsomal 52% vs 37.4%, P &lt; 0.05; thyroglobulin 38.1% vs 4.2%, P &lt; 0.001). Patients with toxic nodular goitres had a lower prevalence of positive microsomal antibodies (P &lt; 0.01), but not of thyroglobulin antibodies (P = 0.1) when compared with patients with Graves' disease. TBI activity measured by a radioreceptor assay was positive in 43 of the 45 (95%) patients with Graves' disease and only 1 of the 17 patients (5.9%) with toxic nodular goitre. It thus appears that TBI activity is a sensitive marker in the diagnosis of Graves' disease and that there is a lower prevalence of thyroglobulin and microsomal antibodies in African patients compared with Indian patients.
Persistent local insulin allergy in a diabetic with chronic lymphatic leukaemia
Authors: Winocour P H , Haeney M 
Published: December 2008

SummaryA 75 year old maturity-onset diabetic developed persistent local allergy to insulin. She had coexistent asymptomatic chronic lymphatic leukaemia. All species of insulin provoked a recurrence of the allergy and attempts at hyposensitization and treatment of the leukaemia produced only marginal benefit. Administration of subcutaneous steroids with insulin relieved the problem, but could not be stopped without relapse. Immunological investigations suggested an immune complex-mediated hypersensitivity reaction to insulin. The later development of immune complex-mediated arthropathy tended to support this suggestion. The lack of histological and immunological evidence of an IgE-mediated reaction suggested that in this case the mechanism of insulin allergy and arthralgia was IgG mediated. We suggest that the chronic leukaemia was implicated in both processes by interfering with homeostatic mechanisms that normally prevent the development of autoallergic disorders.
Rational preoperative evaluation
Authors: Muskett A D , McGreevy J M 
Published: December 2008

Summary
Clinical data from two hundred consecutive patients undergoing surgical procedures at the Salt Lake City VA Hospital form the basis of this study. Results of nine commonly ordered preoperative tests (blood count, differential, electrolytes, chemistry panel, urinalysis, prothrombin time, partial thromboplastin time, electrocardiogram, and chest X-ray) were matched with the preoperative history and physical examination and the outcome of surgery in each patient. Each test was examined by the frequency with which it was ordered, the frequency with which it was abnormal, and the frequency with which the abnormal result affected preoperative care. A prevalence of medical illness was found in this population, with 47.5% having a major cardiovascular diagnosis, 35.5% a metabolic or endocrine disease, and 28% a major pulmonary diagnosis.
A total of 1271 tests were performed, with 477 (35.5%) showing some abnormality. However, only 76 (5.9%) changed the patient's management before surgery. All but five of these abnormalities were predictable from the clinical evaluation and these five were minor. The overall postoperative complication rate was 9%. No complication was attributed to the omission of a preoperative test. No surgical cases were cancelled during the study period based solely on a preoperative test. We conclude that many preoperative tests can be safely eliminated by ordering only those based on a specific abnormality in the history or physical examination, resulting in more cost-effective surgical care.
Another family with acute vitamin D intoxication: another cause of familial hypercalcaemia
Authors: Thomson R B , Johnson J K 
Published: December 2008

Summary
Acute vitamin D intoxication from an unknown source occurred in a family consisting of a grandmother, mother, father and four children aged 14, 11, 8 and 1 1/2 years old. The clinical presentation and response to treatment (which included a diphosphonate preparation and cholestyramine) are described.
Crohn's disease in monozygotic twins
Authors: Rampton D S , Stott R B 
Published: December 2008

Summary
A pair of monozygotic twins with Crohn's disease is described. Both have ileocaecal disease and suffered their first symptoms after living apart for 6 years. The pathogenic role of hereditary and environmental factors is discussed in the light of this and previous reports of twins with Crohn's disease.
Sarcoidosis presenting as multiple pulmonary nodules and nephrotic syndrome
Authors: Vidal F , Oliver J A , Campanya E , Baguer A , Carrera M , Richart C 
Published: December 2008

Summary
A 56 year old man presented with thrombophlebitis, nephrotic range proteinuria and multiple pulmonary nodules. A renal biopsy showed membranous glomerulonephritis, and after a thoracotomy a diagnosis of sarcoidosis was established.
A pulmonary nodular pattern is unusual in sarcoidosis and is often mistaken for malignant disease. The association of this type of pulmonary involvement and membranous glomerulonephritis as the presenting form of sarcoidosis has not previously been described.
Intraventricular haemorrhage complicating a brain abscess
Authors: Pascual J , Diez C , Carda J R , Vázquez-Barquero A 
Published: December 2008

SummaryIntraventricular haemorrhage occurred in a patient with a parietal rim-enhancing mass on computed tomographic scan. At operation a brain abscess was identified and removed. Peptostreptococcus and fusobacterium were isolated, possibly of dental origin. The possible sources of this intracranial bleeding are discussed. A neoplasm should not always be considered in the case of a cerebral ring-enhancing mass complicated with intracranial bleeding; in selected cases, brain abscess should be excluded too.
Tetany despite normocalcaemia and normomagnesaemia following parathyroidectomy
Authors: Fonseca V A , Bloom R D , Dick R , Dandona P 
Published: December 2008

Summary
Two patients with long-standing hyperparathyroidism due to a parathyroid adenoma are described. Both had severe osteitis fibrosa cystica and a proximal myopathy. Both were treated with alfacalcidol (2 micrograms/day) prior to and following parathyroidectomy, and infused with calcium gluconate following the operation. Plasma total and ionized calcium and magnesium concentrations were maintained within the normal range. However, both developed tetany in the postoperative period in spite of normal ionized calcium and magnesium concentrations. Tetany continued for 4 weeks in one patient and for longer in the other. Prolonged hypercalcaemia may result in a state of neuromuscular excitability following parathyroidectomy even at high normal concentrations of ionized calcium.
Prognostic indicators of septicaemia--a two year prospective evaluation
Authors: Iyer R P , Duckett G K , Brogan T D , Tweedy P S , Sharpe T C 
Published: December 2008

Summary
The problem of septicaemia in a district general hospital was studied prospectively over a two year period, with respect to factors affecting prognosis. Age had little influence on the outcome, although several factors showed age-related trends which tended to be unfavourable to survival. The mortality among patients over 65 years of age was 39.5% and this was not significantly different from the mortality of 34.5% among those below that age. It is suggested that by taking into consideration simple clinical and laboratory findings like sex, source of infection, intercurrent illness, blood urea, pulse rate and temperature, it is possible to predict prognosis with reasonable accuracy without recourse to excessive expenditure of money or resources.
Climatic effects on blood pressure in normotensive and hypertensive subjects
Authors: Abdulla K , Taka M 
Published: December 2008

Summary
In a retrospective within-patient study, the arterial pressures of 174 normotensive and 50 hypertensive subjects in winter and summer were compared. Both systolic and diastolic pressures were higher in winter in the two groups but the differences were small and reached statistical significance only in the case of systolic pressure in normotensive subjects.
Pseudotumour cerebri in a patient with Castleman’s disease
Authors: Black D A , Forgacs I , Davies D R , Thompson R P H 
Published: December 2008

Summary
A patient with systemic Castleman’s disease (angiofollicular lymph node hyperplasia) including bone changes and peripheral neuropathy, is described. She also had pseudotumour cerebri, and, as this association has been reported previously, it is unlikely to be due to chance.
Hyperaldosteronism combined with hypercortisolaemia in a patient with adrenal carcinoma
Authors: Panesar N S , Tsao S Y , Wheeler M J , Cockram C S 
Published: December 2008

Summary
A patient with adrenal carcinoma who initially presented with features suggestive of Conn’s syndrome, but subsequently was shown to produce excess cortisol and other steroids, is described.
Cardiac tamponade complicating central venous catheter
Authors: Chamsi-Pasha H , Waldek S 
Published: December 2008

Summary
Cardiac tamponade complicating central venous catheters is usually fatal. We present a 23 year old woman who developed cardiac tamponade 12 hours after the insertion of a subclavian line. Early recognition of this complication and urgent pericardiocentesis led to her survival.
Transthoracic image guided biopsy
Authors: Dick R 
Published: December 2008

Summary
Transthoracic image guided biopsy is now firmly established in the armamentarium of diagnostic tests to establish the nature of a mass in the lung, pleura, mediastinum or chest wall. It may be performed under computed tomographic, ultrasonic or fluoroscopic control, and provided a fine needle technique is employed, morbidity is low. Worldwide reports show a 90% true positive yield and a false positive rate of less than 1%.
Recent observations on drugs and human fertility
Authors: Turner P 
Published: December 2008

Summary
The transmembrane migration method has permitted quantification of the effect of drugs on human sperm motility. Calcium ionophores and calcium antagonists have paradoxical effects on motility depending on the stage of sperm maturity. Drugs with membrane stabilizing properties inhibit sperm motility. Propranolol, for example, has been shown to have contraceptive activity when administered intra-vaginally. Pharmacokinetic studies have shown that the systemic availability of vaginally administered propranolol is markedly greater than after oral administration. Seminal fluid concentrations of propranolol after oral administration are similar to those in plasma, but cervicovaginal mucus concentrations are much higher, and residence times much longer. The clinical consequences of these observations await elucidation.
Recurrent acute renal failure due to a rectal villous adenoma
Authors: Williams B , Pearson H J , Barrie W W , Walls J 
Published: December 2008

Summary
A case is reported in which a rectal villous adenoma was complicated by severe fluid and electrolyte depletion producing recurrent renal failure. The pathophysiology of the depletion syndrome and its complications are discussed. Successful management by acute haemodialysis and early surgical resection of the tumour is described.
Problems with a renal replacement programme in a developing country
Authors: McLigeyo S O , Otieno L S , Kinuthia D M W , Ongeri S K , Mwongera F K , Wairagu S G 
Published: December 2008

Summary
Since August 1984 patients with end-stage renal disease in Kenya have been started on haemodialysis with a view to renal transplantation. In a two year period (August 1984-August 1986) 77 patients mean age 29.6 years (49 males), have been dialysed. The mean duration on dialysis prior to death or transplantation was 2.9 months (range 1 day to 11 months). Fifty patients (65%) died while on dialysis, including 2 who had had unsuccessful transplantation. Fourteen patients were still on dialysis, 11 had discharged themselves to peripheral hospitals for conservative management, and 2 had had successful renal transplantation. The possible causes of this abysmal experience include admission of critically ill patients, shortage of trained staff, over-dependence on arteriovenous shunts for vascular access, lack of centralization of patient management, recurrent shortage of essential equipment and reagents and a slow pace of transplantation.
Long-term symptomatic relief of postprandial hypoglycaemia following gastric surgery with a somatostatin analogue
Authors: D’Cruz D P , Reynard J , Tatman A J , Kopelman P G 
Published: December 2008

Abstract
Somatostatin has been shown to be effective in the management of the dumping syndrome and there have been reports of the effective use of long acting somatostatin analogue in the management of this condition. However, there have been few reports of the prolonged use of a somatostatin analogue in the late dumping syndrome. We describe a patient in whom this management provided good long term symptomatic relief which was confirmed biochemically.
Milk protein allergy--a rare cause of pyrexia of unknown origin in an adult female
Authors: Dhar K L , Gupta B , Adlakha A , Choudhrie A V 
Published: December 2008

Summary
Milk protein allergy is described in a young adult female patient who presented with fever and malabsorption syndrome. The patient fulfilled Goldman’s criteria for the diagnosis of milk protein allergy and responded to an elimination diet.
Extensive aortic valve ring abscess formation: a rare complication of Q fever endocarditis
Authors: Fort S , Fraser A G , Fox K A A 
Published: December 2008

Summary
We report the successful management and 2 year follow up of a young patient with Q fever endocarditis on a congenitally bicuspid aortic valve complicated by extensive abscess formation in the aortic valve ring and interventricular septum. Aortic root abscess formation complicating Q fever endocarditis has been reported in only one previous patient. Serological tests may thus be indicated in patients with aortic abscesses.
Despite extensive aortic and intramyocardial abscess formation it proved possible to control the progression of disease by open drainage of the abscess and aortic valve replacement. Although the requirement for aortic root replacement was anticipated in this patient, it has not been required.
Portal hypertension and ascites in systemic mastocytosis
Authors: Narayanan M N , Liu Yin J A , Azzawi S , Warnes T W , Turck W P G 
Published: December 2008

Summary
We report a case of systemic mastocytosis (SM) presenting as ascites and portal hypertension. The haematological picture at presentation was suggestive of chronic myelomonocytic leukaemia. Initial difficulties in making a diagnosis of SM were encountered as the cutaneous signs were atypical. The correct diagnosis was established only after tissue sections were appropriately stained for mast cells. The liver biopsy showed portal and sinusoidal mast cell infiltration, portal fibrosis and evidence of hepatic venous outflow obstruction. The disease progressed rapidly and recurrent massive ascites was a dominant problem. This case illustrates again the problems of making a diagnosis of SM especially when the clinical picture is atypical. Ascites as a presenting manifestation of SM has been reported previously in only six patients. Published cases of SM with portal hypertension or ascites or both are reviewed.
Neuroleptic malignant syndrome: another medical cause of acute abdomen
Authors: Lo T C N , Unwin M R , Dymock I W 
Published: December 2008

Summary
We present a patient with neuroleptic malignant syndrome and intestinal pseudo-obstruction misdiagnosed as being secondary to septicaemia. The management of the patient is discussed with emphasis on the role of creatine kinase and liver function tests.
Hypercalcaemia associated with chronic viral hepatitis
Authors: Cadranel J F , Cadranel J , Buffet C , Ink O , Pelletier G , Bismuth E , Etienne J P 
Published: December 2008

Summary
A patient with long lasting non-parathyroid hormone mediated hypercalcaemia occurring within the context of hepatitis B virus chronic hepatitis is reported. Hepatocellular carcinoma and bone malignancy were carefully excluded. The biological pattern associated hypercalcaemia with normal phosphataemia, low nephrogenic cAMP level and high level of tubular reabsorption of phosphate. The usual causes of hypercalcaemia were ruled out. Hypercalcaemia may represent a rare biological feature of some advanced liver disease. The underlying mechanisms remain to be elucidated.
Simple avulsion of onychogryphotic toenails: a justifiable treatment?
Authors: Greig J D , Anderson J H , Ireland A J , Anderson J R 
Published: December 2008

Summary
Twenty-nine consecutive patients with onychogryphotic toenails in whom conservative treatment had failed, were entered into the study over a one year period and followed-up prospectively for a further year. All patients were treated by simple nail avulsion. The incidence of recurrence was 27 out of 29 patients (93%); only five of these were symptomatic (17%). Only two patients required further surgery. We conclude that simple avulsion of onychogryphotic toenails offers symptomatic relief in the majority of patients, particularly in this elderly population in whom the use of a tourniquet may be contraindicated.
Familial malignant retroperitoneal paraganglioma
Authors: Sebastian J P , Williams S E , Wells M , Peake M D 
Published: December 2008

Summary
Paragangliomas are neuroendocrine tumours and those occurring in the head and neck have well recognized familial association. Retroperitoneal paragangliomas are uncommon and we present two cases of familial malignant retroperitoneal paraganglioma. Review of the literature revealed marked differences in the incidence and malignant potential of familial and non-familial paraganglioma. In contrast to the cases reported here, familial tumours are generally benign, though they may occur at multiple sites. Familial and non-familial paragangliomas may indeed be different disease entities.
The automatic implantable cardioverter/defibrillator for a life threatening arrhythmia in a case of post-partum cardiomyopathy
Authors: Bower M , Freeman L J , Rickards A F , Rowland E 
Published: December 2008

Summary
We report the development of severe life threatening polymorphic ventricular tachycardia in a young woman shortly following her first pregnancy, who ultimately required the insertion of an automatic implantable cardioverter/defibrillator because of the failure of conventional antiarrhythmic therapy. Although only about 7 patients have received units in the UK to date, the experience in the USA, where up to 300 per month may be implanted, suggests that they will become a more common method of treatment in cases of life threatening arrhythmias.
Severe tissue destruction in the ear caused by alkaline button batteries
Authors: Premachandra D J , McRae D 
Published: December 2008

Summary
Button batteries spontaneously leak corrosive electrolyte solution on exposure to moisture. Tissue in contact with such solution will undergo liquefaction necrosis. Three cases of skin, bone and tympanic membrane necrosis caused by a leaking button battery lodged in the external auditory meatus are described.
Osteomyelitis complicating Streptococcus milleri endocarditis
Authors: Barham N J , Flint E J , Mifsud R P 
Published: December 2008

Summary
A patient with osteomyelitis of the spine complicating bacterial endocarditis due to Streptococcus milleri is discussed. To our knowledge, this is the first time this organism has been associated with this complication.
Recurrent pneumothorax following abdominal paracentesis
Authors: Stafford P J 
Published: December 2008

Summary
A 62 year old man presented with abdominal ascites, without pleural effusion, due to peritoneal mesothelioma. He had chronic obstructive airways disease and a past history of right upper lobectomy for tuberculosis. On two occasions abdominal paracentesis was followed within 72 hours by pneumothorax.
This previously unreported complication of abdominal paracentesis may be due to increased diaphragmatic excursion following the procedure and should be considered in patients with preexisting lung disease.
Late-onset drug fever associated with minocycline
Authors: Gorard D A 
Published: December 2008

Summary
A patient presenting with a pyrexial illness and transiently deranged liver function tests is described. He had been taking minocycline for 12 months. The causal association with this drug was demonstrated by withholding and then rechallenging with minocycline. This report documents drug fever as an adverse reaction to minocycline, and its late onset is of added interest.
Persistent nephrogenic diabetes insipidus, tubular proteinuria, aminoaciduria, and parathyroid hormone resistance following longterm lithium administration
Authors: Neithercut W D , Spooner R J , Hendry A , Dagg J H 
Published: December 2008

Summary
We report a patient who developed persistent nephrogenic diabetes insipidus associated with renal tubular acidosis, renal resistance to parathyroid hormone, aminoaciduria and proximal tubule pattern proteinuria in the presence of a reduced glomerular filtration rate (19–24 ml/min). A review of the previous reports of persistent nephrogenic diabetes insipidus revealed that in all patients the glomerular filtration rate had been less than 60 ml/min at presentation. Chronic renal failure may therefore predispose to the development of persistent nephrogenic diabetes insipidus in patients receiving lithium.
Venepuncture for calcium assays: should we still avoid the tourniquet?
Authors: McMullan A D , Burns J , Paterson C R 
Published: December 2008

Summary
Blood was collected by venepuncture from nine healthy subjects over a ten minute period before applying a standard tourniquet, and over a ten minute period afterwards. Plasma ionised calcium was unaltered by the tourniquet, whereas total calcium, total protein and albumin in serum increased modestly. However, there was no effect on total calcium adjusted for albumin. Even without albumin adjustment the change in total calcium was negligible within one minute of the application of the tourniquet. We consider that in ordinary clinical practice, there is no need to perform venepuncture for calcium assays without a tourniquet.