bluuebunny/crossref_metadata_2025_split huggingface dataset:
Should patients with haemoptysis and a normal chest X-ray be bronchoscoped?
Authors: Heaton R W 
Published: December 2008

Summary
A review of bronchoscopic records over a 5 year period identified 41 patients who had undergone fibreoptic bronchoscopy after presenting with haemoptysis and a normal chest X-ray. Carcinoma of the bronchus was found in 4 patients (9.7%) and the procedure yielded a diagnosis in 8 of the 20 patients in whom a specific cause of their bleeding could be identified. The diagnostic yield is sufficiently high and the morbidity of the procedure sufficiently low to justify the investigation in patients presenting with haemoptysis and a normal chest X-ray.
Extra-corporeal shock wave lithotripsy
Authors: Pemberton J 
Published: December 2008

Summary
Extra-corporeal shock wave lithotripsy (ESWL) has proved to be a revolutionary advance in the treatment of renal stone disease. It, itself, is non-invasive but may necessitate or be used as an adjunct to more invasive auxiliary procedures. The basic principles of lithotripsy, the clinical experience thus far and probable future applications are discussed.
Paroxysmal kinesigenic choreoathetosis in hyperthyroidism
Authors: Drake M E 
Published: December 2008

Summary
Paroxysmal kinesigenic choreoathetosis is an unusual movement disorder often triggered by attempts to use the limbs, and has sometimes been associated with diffuse or focal brain injury. We report its occurrence in hyperthyroidism, with which choreoathetosis has rarely been described in the past without known cause. Choreoathetosis has also occurred with other metabolic and toxic disorders, and the mechanism is uncertain. The development of involuntary movements activated by limb motion during hyperthyroidism suggests an influence by thyroid hormone or metabolic state on motor neurone excitability or motor system organization.
Compression of the optic chiasm due to a lymphoreticular malignancy
Authors: Howard R S , Duncombe A S , Owens C , Graham E 
Published: December 2008

Summary
A patient is described who presented with visual loss due to infiltration of the optic chiasm by chronic lymphocytic leukaemia. This case demonstrates intracranial infiltration as a primary presentation of chronic lymphocytic leukaemia without lymphoreticular involvement and, to our knowledge, is the first report of a chiasmal syndrome due to this lymphoproliferative disorder.
Cerebral scintigraphy--the phoenix rises again
Authors: Shepstone B J 
Published: December 2008

Summary
This paper reviews the development of cerebral scintigraphy from its early days of planar imaging with simple technetium-99m labelled compounds to the recent revival of the technique in the form of positron-emission and single-photon emission tomography. A short explanation of instrumentation and radiopharmaceuticals is given as a prelude to a description of both techniques in normal and pathological situations. Particular emphasis is placed on the more readily-available single-photon emission-tomographic techniques using labelled amines in the functional investigation of disorders not readily diagnosed by computed tomography.
Relapse of idiopathic pulmonary haemorrhage and glomerulonephritis associated with cytomegalovirus (CMV) infection
Authors: Chan C N , Lai F M , Lai K N , Pang J A 
Published: December 2008

Summary
A 49 year old man who developed idiopathic pulmonary haemorrhage and glomerulonephritis responded initially to immunosuppressive treatment and plasmapheresis. However, he died later from massive pulmonary haemorrhage and necropsy showed cytomegalovirus infection of the lungs. We propose that relapse of pulmonary haemorrhage may be associated with cytomegalovirus infection and that preventive measures against acquiring the virus through blood products should be considered for elective transfusions in view of the relatively good long term prognosis of this syndrome.
An unusual case of oesophageal rupture treated by transhiatal oesophagectomy
Authors: Park K , Crofts T J , Chung S C S , Li A K C 
Published: December 2008

Summary
Spontaneous rupture of the oesophagus is an uncommon surgical emergency. A case is presented in which the extensive nature of the rupture precluded standard methods of treatment and was treated by transhiatal oesophagectomy.
Penile hyperexcitability with recurrent ejaculations as the presenting manifestation of a case of rabies
Authors: Udwadia Z F , Udwadia F E , Rao P P , Kapadia F 
Published: December 2008

Summary
A patient with rabies presented with penile hypersensitivity and recurrent ejaculation. This preceded the more classical manifestations such as hydrophobia and aerophobia by approximately 8 hours. A review of the literature reveals that a variety of urogenital symptoms may rarely occur in rabies. Ours is however the first report documenting the occurrence of these symptoms at the onset of the disease in an autopsy proven case of rabies. Damage to the amygdaloid nucleus has been postulated to be the basis of these urogenital symptoms. This correlates well with our autopsy findings of extensive neuronal damage and Negri bodies in the temporal poles.
Haemolytic anaemia associated with splenic haemangiomata
Authors: Radhi J M , Wallis J P , Mansy H 
Published: December 2008

Summary
We describe a 33 year old woman who developed unexplained haemolytic anaemia following renal transplantation and who was found to have multiple splenic haemangiomata. This case demonstrates that splenic haemangiomata may be a cause of haemolytic anaemia in the absence of abnormalities in coagulation.
Left ventricular thrombosis in acute transmural myocardial infarction
Authors: Chamsi-Pasha H , Barnes P C 
Published: December 2008

Summary
To determine the incidence and natural history of left ventricular thrombosis in acute transmural myocardial infarction we performed serial two-dimensional echocardiography in 51 patients. Seventeen patients had inferior infarcts. None of these developed left ventricular thrombosis. The remaining 34 patients had anterior infarcts. Ten of these developed left ventricular thrombus at an average of 4 +/- 2 days after admission. All patients with left ventricular thrombosis had apical akinesia or dyskinesia.
Patients with anterior myocardial infarction and akinesia or dyskinesia of the apex are at high risk of developing left ventricular thrombosis. Peak aspartate aminotransferase and lactate dehydrogenase enzyme activity were of little value in identifying this high risk group.
The carpal tunnel syndrome in hypertensive patients treated with beta-blockers
Authors: Emara M K , Saadah A M 
Published: December 2008

Summary
We report the development of the carpal tunnel syndrome in 3 hypertensive men (aged 46-58) treated with beta-blockers (propranolol in two patients and metoprolol in the 3rd) for 8-11 years. Known causes of carpal tunnel syndrome were excluded in each case. Withdrawal of the beta-blocker was followed by complete resolution of symptoms and signs after a period of 8-10 weeks. No evidence of recurrence could be detected during follow-up of 7-18 months. The possible mechanisms of drug-induced carpal tunnel syndrome are briefly discussed.
The swallowed foreign body: is it in the nasopharynx?
Authors: Parker A J , Bingham B J , Osborne J E 
Published: December 2008

Summary
Children with a history of a suspected swallowed radio-opaque foreign body should undergo radiographic examination of the nasopharynx even in the absence of symptoms and signs. Failure to identify and remove an object at this site can result in potentially fatal consequences.
Estimation of glomerular filtration rate from the serum creatinine concentration
Authors: Smith S A 
Published: December 2008

SummaryIn patients with renal failure the dose of renally excreted drugs should be reduced in proportion with the degree of impairment of glomerular filtration: in this situation it is appropriate to measure the glomerular filtration rate in order to determine accurately the correct dose. However, as 24 hour urine based creatinine clearance measurements are time consuming and inaccurate, the parameter most often used to estimate renal function in clinical practice is the serum creatinine concentration. An isolated serum creatinine concentration is unsatisfactory for this purpose as it depends on creatinine production, which is related to muscle mass, as well as on renal elimination of creatinine. A variety of formulae and nomograms have been devised to assist clinicians in predicting the glomerular filtration rate from a stable serum creatinine concentration and the patient’s sex, age and weight (or height). Although some of these formulae have been available for over 15 years, the majority of doctors cannot estimate accurately the glomerular filtration rate from these parameters. It is proposed in this paper that biochemistry results computers should employ one of these formulae to calculate the glomerular filtration rate/70 kg, using the age and sex information provided on the request form, each time a serum creatinine concentration is reported. These formulae are invalid in several well defined clinical situations which could be briefly outlined on the report.
Effect of nivazol in Nelson’s syndrome
Authors: Ball J A , Williams G , Yeo T H , Joplin G F 
Published: December 2008

Summary
We report the use of nivazol in a patient with Nelson’s syndrome. Nivazol was highly effective in reducing ACTH secretion but, contrary to reports of its use in other primates, in our patient nivazol did have systemic glucocorticoid effects.
Myalgias and muscle contractures as the presenting signs of Addison’s disease
Authors: Shapiro M S , Trebich C , Shilo L , Shenkman L 
Published: December 2008

Summary
Severe generalized myalgias and muscle contractures of the lower extremities were the major initial manifestations of adrenal insufficiency in a 26 year old black male. The intensity of increased skin pigmentation was not fully appreciated until the patient’s skin colour was compared to that of his brother. Replacement with physiological doses of gluco- and mineralocorticoids was associated with complete amelioration of symptomatology.
Cardiac arrest associated with hypokalaemia in a patient receiving mithramycin
Authors: Bashir Y , Tomson C R V 
Published: December 2008

Summary
The case is reported of a patient who developed severe hypokalaemia, leading to cardiac arrest, while receiving mithramycin for painful Paget’s disease. The patient was also receiving antihypertensive and anti-anginal treatment including bendrofluazide, but plasma potassium before the administration of mithramycin was normal. Hypokalaemia has been reported in previous studies of the use of mithramycin but has received little attention. The drug should be used with great care in patients with cardiovascular disease and in those receiving diuretics.
Failure of penicillin prophylaxis in laboratory acquired leptospirosis
Authors: Gilks C F , Lambert H P , Broughton E S , Baker C C 
Published: December 2008

Summary
A laboratory technician developed leptospirosis following accidental inoculation, despite prompt administration of parenteral penicillin by an accepted regimen of post-exposure prophylaxis. Another technician was similarly exposed and was given doxycycline; no illness or serological conversion followed. The implications of these cases are discussed and recommendations made for post-exposure chemoprophylaxis with doxycycline.
The low plasma testosterone levels of young Indian infarct survivors are not due to a primary testicular defect
Authors: Sewdarsen M , Jialal I , Naidu R K 
Published: December 2008

Summary
A case control study was performed to determine whether the hypotestosteronaemia described in men with coronary artery disease could be the result of primary testicular dysfunction. Testicular function was assessed by comparing the response of 10 young Indian men with myocardial infarction to human chorionic gonadotrophin (HCG) injection to that of 10 healthy age and weight matched controls.
The basal testosterone levels in the patients were significantly lower (12.71 +/- 1.36 nmol/l vs 16.51 +/- 0.79 nmol/l; P = 0.01) and the basal oestradiol levels significantly higher than the controls (120.67 +/- 8.81 pmol/l vs 94.05 +/- 8.23 pmol/l; P = 0.02). There was no difference in the sex hormone binding globulin concentrations. However, following HCG stimulation the patients demonstrated a normal response with a 2-fold increase in testosterone. There was no difference in the testosterone and oestradiol levels of the patients and controls following HCG stimulation.
This normal response in our patients demonstrates that the hypotestosteronaemia in Indian men with myocardial infarction is not due to a primary testicular dysfunction but probably is a result of increased aromatization of testosterone to oestradiol.
Autoantibodies in Indian-Asians with insulin-dependent diabetes in the UK
Authors: Odugbesan O , Fletcher J A , Sanders A , Bradwell A R , Botazzo G F , Barnett A H 
Published: December 2008

SummaryClassical insulin-dependent diabetes mellitus (IDDM) is relatively uncommon in Indian-Asians whether in India or in the UK and this may be related to immunogenetic factors. We have studied the presence or absence of islet cell antibodies and other auto-antibodies in 36 subjects with IDDM and 41 controls, all of Indian origin. Islet cell antibodies (ICA-IgG) were found in 8 subjects with IDDM but in none of the controls. Four of the 8 patients with ICA-IgG also possessed the complement fixing variety (CF-ICA). There was no definite association between possession of ICA and HLA-DR antigens. Thyroid antibodies were commoner in patients (22%) compared with controls (7%) as were parietal cell antibodies (8.3% vs 4.8%). None of the patients or controls had adrenal antibodies.The frequency of organ-specific antibodies in Indian-Asians with IDDM is similar to that of white Caucasians. The overall frequency of ICA is, however, lower than that reported for white Caucasians although the temporal distribution is similar. We conclude that even though the prevalence of IDDM in Indian-Asians is lower than in white Caucasians there is no evidence that different immunological mechanisms are involved in the pathogenesis of IDDM in the two groups.
Cerebellar disturbance in psittacosis
Authors: Shee C D 
Published: December 2008

Summary
A previously fit man developed psittacosis with marked cerebellar symptoms and signs. He was febrile but not confused, and he responded rapidly to treatment with erythromycin. Even if respiratory symptoms are minimal, psittacosis and other atypical pneumonias should be considered in any patient presenting with fever and cerebellar involvement.
A case of metachronous aneurysm of the infrarenal abdominal aorta
Authors: Millard F C , Powis S J A 
Published: December 2008

Summary
The case history of an 84 year old woman presenting with a metachronous aneurysm of the infrarenal abdominal aorta is presented. At operation this second aneurysm was replaced by a further straight tube Dacron inlay graft. This report raises the important question as to whether the whole of the infrarenal aorta should be replaced when resecting an infrarenal abdominal aortic aneurysm, rather than the more conventional approach of suturing the graft to the neck of the aneurysm above and the aortic bifurcation below.
Retinal vasculitis
Authors: Sanders M D , Graham E M 
Published: December 2008

Summary
Evidence is now accumulating on both clinical and experimental grounds that the retina is an a priori source of inflammatory activity. Reactive inflammation in the retina may produce many of the clinical signs previously ascribed to uveal inflammation. Autoimmune mechanisms are probably responsible for the majority of cases of retinal vasculitis. Autoimmune retinal vasculitis occurs without other classical signs of inflammatory response in any other parts of the body. When associated systemic manifestations occur they may reflect different underlying immunopathogenic abnormalities.
Thus in diseases with predominantly arterial involvement (e.g. systemic lupus erythematosus, polyarteritis nodosa) the retinal arteries bear the brunt of this disease. In Behçet’s disease the systemic involvement is usually venous and ocular involvement produces diffuse capillary and venous inflammation with areas of retinal necrosis and major vascular occlusion. The retinal appearances differ from sarcoidosis in which a granulomatous response produces characteristic periphlebitis. Finally, autoimmune retinal vasculitis produces diffuse capillary and venous damage, without any systemic signs.
In the next decade the search will be for the identification of the specific antigens initiating these disparate retinal features. Retinal S antigen is a potent antigen, but rhodopsin, interphotoreceptor binding protein, and transducin all need further experimental investigation. Precise documentation will herald the dawn of new therapeutic measures based on a sound immunological fabric.
The changing face of chemotherapy
Authors: Brumfitt W , Hamilton-Miller J M T 
Published: December 2008

Summary
The historical development of antibiotics has been summarized. Three distinct phases are discernible. The first (from historical times to about 1900) involved mostly folk remedies. The second (1900-c. 1940) was ushered in by Paul Ehrlich’s development of the concept of ‘selective toxicity’ and saw the establishment of arsenicals and sulphonamides. The third, lasting to the present day, started with the exploitation of the pioneering studies of Fleming, Dubos and Waksman on antibiotic production by soil fungi. This latest phase has continued with the improvement of natural products by the skills of the medicinal chemist. The properties and evolution of three major groups of antibiotics, penicillins, cephalosporins and aminoglycosides are fully described. Finally, pathways of possible future evolution of antibiotics are outlined.
Carcinoma of the gall bladder--can we do anything?
Authors: Chattopadhyay T K , Kumar A , Kapoor V K , Sharma L K , Kapur M M , Kapur B M L , Dhawan I K 
Published: December 2008

Summary
A retrospective review of 143 cases of carcinoma of the gall bladder is presented. The disease was more common in females in the 5th and 6th decades. Pain, anorexia, weight loss and jaundice were the common presenting symptoms, and hepatomegaly and palpable gall bladder the common signs. Laboratory and radiological investigations were merely confirmatory as the diagnosis in a majority of the cases was clinically obvious. Aspiration cytology and laparoscopic biopsy were of help in obtaining histological diagnosis. Only 47 patients were considered fit enough to undergo laparotomy. In a majority of these patients biopsy alone was possible while palliative procedures were performed in the others. The operative mortality was 18% even in this selected group of patients, due to the poor general condition and the advanced stage of the disease at the time of diagnosis. Curative resection may be possible and long term survival is expected in incidentally found carcinoma at cholecystectomy. The only hope lies in prevention by prompt treatment of patients with benign biliary disease.
A descriptive survey of uncontrolled methicillin-resistant Staphylococcus aureus in a twin site general hospital
Authors: Barrett S P , Gill O N , Mellor J A , Bryant J C 
Published: December 2008

Summary
Over a five year period beginning in 1981, during which control measures were applied intermittently, the incidence of methicillin-resistant Staphylococcus aureus (MRSA) isolates increased steadily within a twin site general hospital. A retrospective chart review of 154 patients identified in 1984-1985 showed that the MRSA ‘definitely’ contributed to three deaths (2%) and ‘probably’ contributed to a further 15 (10%). The prolonged median duration of hospital admission (22 days) before first isolation of MRSA, together with the clustering of cases in time on certain wards, suggested that most, if not all, affected patients acquired the MRSA in hospital. As the virulence of MRSA in our outbreak appeared the same as that reported from teaching hospitals, MRSA control measures need to be comprehensively applied in general hospitals.
Colonic bleeding due to rupture of an isolated iliac artery aneurysm into a caecal carcinoma
Authors: Aladgem D , Mazor A , Kashtan H , Ostrzega N , Barak Y , Wiznitzer T 
Published: December 2008

Summary
We describe a case of a fistula between an atherosclerotic aneurysm of the right common iliac artery and a caecal carcinoma, causing massive colonic bleeding. A fistula between a true aneurysm and a carcinoma of the colon has not to our knowledge been previously reported. Various aspects of this case are discussed from a pathogenetic point of view.
Anorectal melanoma
Authors: Jalleh R P , Pathmanathan R , Krishnan M M S , Mukherjee A 
Published: December 2008

Summary
Four cases of anorectal melanoma are presented. The authors believe that this is the first report of the occurrence of this tumour in Malays. Advanced disease at initial presentation accounts for the poor prognosis observed in this series. Surgery remains the principal treatment modality, although controversy exists regarding optimal extent of resection.
Attitudes to a hospital based terminal care scheme
Authors: McKee C M , Rajaratnam G , Lessof L 
Published: December 2008

Summary
Two years after the establishment of a terminal care support team, the team perceived that a number of patients were not being referred to them, and many of those seen were referred at a very late stage in their illness. We sent a questionnaire to all clinicians and ward sisters in the district to elicit their knowledge of the team and attitudes to their role. Although most respondents had cared for terminal patients in the previous 6 months, over a quarter were not aware of the existence of the team. The lack of awareness was most common among junior medical staff, many of whom were spending relatively short times in the district. The study indicated a requirement for good communication between terminal care teams and other professionals and a need to inform junior staff about available facilities. A requirement for training in terminal care was also identified.
Delayed sudden death after ingestion of MCPP and ioxynil: an unusual presentation of hormonal weedkiller intoxication
Authors: Dickey W , McAleer J J A , Callender M E 
Published: December 2008

Summary
A patient who died in asystole less than 18 h after ingestion of ‘Clovercide Extra’, a combination hormonal weedkiller containing ioxynil and 4-chloro-2-methyl phenoxypropionic acid, is described. Previous reports describe coma as an early event following ingestion of these herbicides. In contrast our patient, although showing other characteristic features, including metabolic acidosis, tachycardia, pupillary constriction and pyrexia, remained conscious until the terminal event. Absence of coma does not appear to be related to a more favourable outcome.
Aeromonas hydrophila septicaemia and muscle abscesses associated with immunosuppression
Authors: Slevin N J , Oppenheim B A , Deakin D P 
Published: December 2008

Summary
We report a case of septicaemia and muscle abscesses due to Aeromonas hydrophila. The patient was immunosuppressed due to Hodgkin’s disease and treatment with cytotoxic chemotherapy. The abscesses resolved after prolonged antibiotic therapy. Organisms that were once considered rarely pathogenic are emerging as increasingly important in causing potentially lethal infections in immunosuppressed patients.