bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hepatic epithelioid haemangioendothelioma: difficult name, difficult diagnosis?
Authors: Cobden I , Johri S , Terry G , Robinson K B , Bennett M K , Lendrum R 
Published: December 2008

Summary
Two patients with epithelioid haemangioendotheliomata of the liver are described. Both presented with abdominal pain and malaise, with hepatomegaly and a variable degree of hepatocellular dysfunction. Diagnosis was delayed in both cases, each patient undergoing a protracted series of investigations including repeated liver biopsies. The major obstacles to early diagnosis were a lack of clinical awareness of the condition and difficulties in interpretation of the liver histology: the widespread sclerosis in the tumour tissue is easily mistaken for a post-necrotic or cirrhotic process. The key to the diagnosis is the demonstration of cells containing Factor-VIII-related antigen confirming the endothelial origin of the tumour. One patient died within three months of presentation and the other after 18 months. The tumour may, therefore, be more aggressive than earlier reports seem to suggest. It seems likely that the tumour is being under-diagnosed and although no specific therapy has been shown to be of value, a greater awareness of the condition, resulting in a more prompt diagnosis, should save patients from undergoing unnecessary investigation.
Melioidosis with brain abscess
Authors: Pit S , Chea F K C , Jamal F 
Published: December 2008

Summary
Central nervous system involvement in melioidosis is rare. We describe a 48 year old woman who developed septicaemia and a brain abscess due to Pseudomonas pseudomallei. Since there is a continuing practical problem in bacteriological confirmation of the aetiological agent, diagnosis of melioidosis has to be made on clinical suspicion.
Ectopic release of GHRH and ACTH from an adenoid cystic carcinoma resulting in acromegaly and complicated by pituitary infarction
Authors: Southgate H J , Archbold G P R , El-Sayed M E , Wright J , Marks V 
Published: December 2008

Summary
A 23 year old man presented with a tumour mass in the lung. Subsequent investigation showed ectopic secretion of adrenocorticotrophic hormone (ACTH) and growth hormone releasing hormone (GHRH) from an adenoid cystic carcinoma. The patient progressed to show the clinical effects of long term exposure to high blood levels of both growth hormone and cortisol. The case was complicated by pituitary infarction. The very high blood levels of ACTH, growth hormone (GH) and GHRH proved resistant to treatment with the somatostatin analogue, SMS 201-995, and a possible side effect of the drug is reported. To our knowledge this is the first reported case of ectopic hormone secretion by an adenoid cystic carcinoma.
Multiple smooth muscle tumours in neurofibromatosis presenting with chronic gastrointestinal bleeding
Authors: Cox J G C , Royston C M S , Sutton D R 
Published: December 2008

Summary
Gastrointestinal involvement in neurofibromatosis is well recognised. We present an unusual manifestation of gastro-intestinal neurofibromatosis--chronic gastrointestinal bleeding from extensive smooth muscle tumours.
Neurological complications of human immunodeficiency virus infection
Authors: Kennedy P G E 
Published: December 2008

Summary
The protean neurological manifestations of human immunodeficiency virus (HIV) infection are reviewed. Both the central nervous system and peripheral nervous system may be affected and many of the complications may occur in individuals with acquired immunodeficiency syndrome (AIDS)-related complex, or who are seropositive for HIV alone as well as those with the established AIDS syndrome. Specific therapy is available for certain of these neurological conditions, but the clinical course in others is untreatable and progressive. Although it seems likely that the pathogenesis of some of these syndromes such as the AIDS-dementia complex are due to the direct effect of HIV on the nervous system, in others the neurological injury probably occurs as a consequence of the immunosuppression which HIV induces, or immune-mediated mechanisms.
Graves’ disease presenting as pyrexia of unknown origin
Authors: Shaked Y , Samra Y , Zwas S T 
Published: December 2008

Summary
Fever is a common clinical manifestation of inflammatory processes of the thyroid and thyroid crisis. On the other hand, fever alone as a presenting symptom of thyrotoxicosis, without other manifestations, is extremely rare. A female patient is described in whom fever persisted for two months prior to hospitalization, but without clinical symptoms or signs to lead to suspicion of thyroid disease. After exhaustive investigation it was found that the patient was suffering from hyperthyroidism. Fever disappeared gradually on antithyroid therapy, recurred when the drugs were withdrawn for a rechallenge trial, and cleared up again after renewal. Four other cases of persistent fever as a presenting symptom of hyperthyroidism were found on a review of previous publications. Thyrotoxicosis should, therefore, be included in the differential diagnosis of pyrexia of unknown origin.
Lactic acidosis due to metformin therapy in a low risk patient
Authors: Tymms D J , Leatherdale B A 
Published: December 2008

Summary
A 55 year old diabetic women treated with chlorpropamide and metformin for three years presented with acute oliguric renal failure and lactic acidosis from which she died. The plasma metformin level was very high suggesting that the lactic acidosis was caused by the drug. There were no contraindications to metformin therapy and renal function was normal three months previously. This case demonstrates that lactic acidosis can occur as a result of metformin therapy in the absence of pre-existing risk factors.
Idiopathic retroperitoneal fibrosis--is serum alkaline phosphatase a marker of disease activity?
Authors: Barrison I G , Walker J G , Jones C , Snell M E 
Published: December 2008

Summary
Two patients are presented in whom extensive investigations were carried out to determine the cause of a raised serum alkaline phosphatase. Idiopathic retroperitoneal fibrosis was diagnosed in both cases and the serum alkaline phosphatase returned to normal following treatment with corticosteroids and coincident with resolution of the patients’ symptoms.
Neuropsychiatric symptoms following bismuth intoxication
Authors: Weller M P I 
Published: December 2008

Summary
A number of seemingly neurotic symptoms, similar to those reported in bismuth intoxication, occurred in a patient taking a proprietary dyspeptic preparation, tri-potassium dicitrate bismuthate (De-Nol), over 2 years. The symptoms remitted over 10-12 months after stopping the drug - a similar period to that described in bismuth intoxication and the patient has remained symptom-free for 7 years. Possible mechanisms are discussed.
Spontaneous duodenocutaneous fistula: a rare complication of duodenal ulcer
Authors: Reddy A N 
Published: December 2008

Summary
Fistula formation between the duodenum and the skin of the anterior abdominal wall is a rare complication of duodenal ulcer disease, most often felt to occur following ulcer surgery. The development of a spontaneous duodenocutaneous fistula in association with duodenal ulcer has not been hitherto reported. A middle aged man with a history of peptic ulcer for more than 10 years, and a vagotomy and pyloroplasty 15 months earlier, presented with an asymptomatic duodenocutaneous fistula, presumably secondary to a perforated duodenal bulb ulcer. Successful healing of the fistula was accomplished by non-surgical therapy consisting of nasogastric suction, intravenous alimentation and parenteral cimetidine over a 4-week period.
Pyogenic liver abscess with two normal ultrasound scans
Authors: Bunney R G 
Published: December 2008

Summary
I report a case of a large liver abscess causing a severe debilitating condition in which the diagnosis was delayed by several weeks following two normal ultrasound scans at days 5 and 19 of the illness.
Up to one in four cases of liver abscess can be missed on ultrasound. A high degree of clinical suspicion must be maintained and repeated or alternative imaging methods used if the diagnosis of this rare, curable but often fatal condition is not to be missed.
Bilateral inguinal hernias: simultaneous or sequential repair?
Authors: Stott M A , Sutton R , Royle G T 
Published: December 2008

Summary
Two hundred and forty four patients underwent either simultaneous bilateral inguinal hernia repair (n = 122) or unilateral inguinal hernia (n = 122) repair at a general hospital between January 1971 and December 1981. The two groups of patients were matched for age and sex. Both groups had a similar overall incidence of post-operative complications and in both groups the duration of post-operative stay and duration of operating time were similar. Chest infections developed in 12 patients after bilateral repair and in 3 patients after unilateral repair (P less than 0.02). All patients were assessed prospectively from 4 to 15 years after operation, when no significant difference in the number of recurrent hernias was found. Our results suggest that simultaneous bilateral inguinal herniorrhaphy is economical in terms of both operating time and duration of hospital stay, and that this economy is not bought at a cost of increased short term morbidity or long-term recurrence rate.
Alveolar soft-part sarcoma: a hormone-sensitive tumour?
Authors: Pang J A , Yeung T F , Cockram C S 
Published: December 2008

Summary
Alveolar soft-part sarcoma is a rare, slow-growing, malignant tumour which metastasizes frequently to the lungs. Treatment with radiotherapy or chemotherapy is largely ineffective, and most patients die within 4 years of developing metastases. We report an unusual patient who survived 9 years after detection of pulmonary metastases. Initial treatment with cytotoxic chemotherapy was ineffective. However, during subsequent treatment with Chinese herbs when she developed galactorrhoea and amenorrhoea (probably due to drug-induced hyperprolactinaemia), her lung metastases regressed, and it is likely that this contributed to her prolonged survival. We hypothesize that alveolar soft-part sarcoma may be a hormone-sensitive tumour, and hormonal manipulation may be an alternative form of treatment which is worth considering.
Foscarnet as treatment for cytomegalovirus retinitis following bone marrow transplantation
Authors: Ganly P S , Arthur C , Goldman J M , Schulenburg W E 
Published: December 2008

Summary
This report describes a patient with chronic granulocytic leukaemia who developed cataracts on busulphan treatment. Following allogeneic bone marrow transplantation, he developed cytomegalovirus retinitis, which was treated successfully with trisodium phosphonoformate (foscarnet). Cytomegalovirus retinitis and its therapy, and busulphan-induced cataract are discussed.
Serious complications following treatment of chronic idiopathic thrombocytopenic purpura
Authors: Wanachiwanawin W , Visudhiphan S , Piankijagum A , Vatanavicharn S 
Published: December 2008

Summary
Six patients had serious complications as consequences of treatment of idiopathic thrombocytopenic purpura. Five had splenectomy-related complications, one of them developed fatal intra-abdominal bleeding. Three patients acquired operation-related serious infection, two of them died. Serious neutropenia after vinblastine-loaded platelets occurred in one patient leading to pseudomonas septicaemia and panophthalmitis with permanent vision loss of left eye. Recurrence thrombocytopenia occurred in every case during serious complications. Early detection by awareness of the possibility of serious complications can reduce morbidity and mortality occurring after therapy of idiopathic thrombocytopenic purpura.
Haemolytic anaemia associated with ingestion of naphthalene-containing anointing oil
Authors: Ostlere L , Amos R , Wass J A H 
Published: December 2008

SummaryWe present a patient who developed a severe haemolytic anaemia as a result of ingestion of a naphthalene-containing anointing oil. Previous reports of naphthalene-induced haemolytic anaemia are reviewed. Predisposing factors to haemolysis are outlined and the variability in the haematological response to naphthalene is discussed. It is clear that ingestion of anointing oil is dangerous; even topically, significant absorption of naphthalene may occur especially in infants, as it is oil-based. Because of these dangers, the use of naphthalene-containing anointing oils should be strongly condemned.
Bilateral dislocation of the shoulders due to nocturnal hypoglycaemia
Authors: Litchfield J C , Subhedar V Y , Beevers D G , Patel H T 
Published: December 2008

Summary
A young insulin-dependent diabetic awoke with apparently spontaneous bilateral anterior dislocation of his shoulders. The most likely explanation was nocturnal hypoglycaemia. Similar case reports describing this complication have not been discovered.
Pericardial involvement in familial Mediterranean fever
Authors: Erol C , Sonel A , Candan İ , Ömürlü K , Ȧkyol T 
Published: December 2008

Summary
Two patients with familial Mediterranean fever showed the classic features of pericardial involvement and one of them (Case 2) had pericardial effusion detected by echocardiography.
These and previously published cases show that familial Mediterranean fever should be considered as a cause of pericarditis and/or pericardial effusion.
Pancreatic pleural effusion associated with oncocytic carcinoma of the pancreas
Authors: England D W , Kurrein F , Jones E L , Windsor C W O 
Published: December 2008

SummaryA pancreatic pleural effusion is an uncommon presenting feature of pancreatic malignancy. A case is described where such an effusion was associated with an oncocytic carcinoma of the pancreas, a tumour which itself has been reported on only one previous occasion.
Premises for immune interventional therapy in rheumatoid arthritis
Authors: Mackay I R , Rowley M J 
Published: December 2008

SummaryConsideration of rheumatoid arthritis (RA) as an autoimmune disease includes initiating event(s), genetic predisposition, immune regulatory derangements, and effector cycles of articular damage. The initiating event is still unknown. Collagen type 2 has good claims as a rheumatogenic autoantigen which perpetuates disease. The association of HLA DR4 with rheumatoid arthritis is in part explainable by the affinity of binding of the rheumatogenic antigen to a hypervariable portion of MHC Class II molecules with selective presentation of this complex to T cell receptors. Immune regulatory derangements include lymphokine-induced aberrant expression of MHC Class II molecules on synovial tissues, the presence of a ‘resistant’ subset of B cells (CD5 + ve), failure of anti-idiotypic control of autoantibodies (not well established as yet in rheumatoid arthritis), and defective immune suppression, revealed by low counts in synovial fluids of a suppressor-inducer subset of CD4 + ve T cells. The many possibilities for therapeutic immune intervention would include polyclonal or monoclonal antibody to block (a) receptors for antigen on B or T lymphocytes (but this would require knowledge of the rheumatoid arthritis-inducing antigen), (b) the CD4 complex on helper T lymphocytes, (c) MHC Class II (Ia) molecules, for which there are excellent prototypes in experimental immunopathology, or (d) lymphokines or their receptors. Induction of suppression by ‘tolerogenic vaccines’ is experimentally validated, but only for diseases for which an autoantigen can be identified.
Immune aspects of sarcoidosis
Authors: Poulter L W 
Published: December 2008

SummaryAlthough the initiating factor(s) is unknown, it is now accepted that pulmonary sarcoidosis develops as a result of an over-stimulated local cellular immune response. Starting as a lymphocytic alveolitis, there is a progression to granuloma formation within the interstitium as stimulated T lymphocytes release mediators capable of attracting and activating monocytes to differentiate into macrophages and epithelioid cells. We are also aware that macrophage-like cells must act as antigen presenters to initiate T cell stimulation within the immune response. To date, interest in the alveolar macrophages of patients with sarcoidosis has focused more on their passive role as responders of the soluble T cell products released as the disease progresses. This paper explores the active role of mononuclear non-lymphoid cells as inducers of immune responses, by taking advantage of monoclonal antibodies capable of discriminating between phenotypically distinct subsets of macrophages. Recent results are presented that suggest a central role for these cells in controlling the course of this disease, focusing specifically on the mechanisms underlying the failure in some patients to resolve the interstitial inflammation and subsequently progressing to fibrosis. A new hypothesis proposes that aberrations in the functional capacity of macrophages may prohibit the emergence of a granuloma-resolving mechanism in some sarcoid patients.
Post-infectious disease syndrome
Authors: Bannister B A 
Published: December 2008

Summary
Many post-infectious syndromes have been recognized in the last 50 years, some following viral infections and others closely related to bacterial disease. The occurrence of prolonged fatigue following an apparent viral illness of varying severity is also well documented. The lack of a recognizable precipitating cause and the tendency for epidemic fatigue to occur among hospital staff led many to believe that the illness may be psychogenic in origin. However, there is serological evidence that some cases may follow enterovirus infections or occasionally delayed convalescence from infectious mononucleosis.
Much interesting work is currently in progress relating fatigue to persisting immunological abnormalities, and the development of molecular immunology makes this a most exciting field of research.
This paper reviews the evidence for and against a definitive post-viral fatigue syndrome and examines the results of research carried out in the last 50 years.
Augmentation and reduction mammaplasty: demographic and obstetric differences in women attending a National Health Service clinic
Authors: Birtchnell S , Lacey J H 
Published: December 2008

Summary
Women presenting for breast augmentation and breast reduction to a National Health Service plastic surgery/psychiatry liaison clinic appear to differ beyond the anatomical. Those requesting breast reduction tend to be younger, unmarried and not to have been pregnant and may be uncomfortable with adult sexuality. Those requesting breast augmentation are presenting for surgery in their mid-thirties although many have always had small breasts. This is at a time of fading attractiveness, marital difficulties and a sense of failure as a woman. We report a strikingly poor obstetric history in this group.
Mycotic aneurysm of the popliteal artery following right hemicolectomy
Authors: Narula A , Lake S P , Baker A R , Greenwood R K 
Published: December 2008

Summary
A case of mycotic aneurysm of the popliteal artery, following right hemicolectomy for carcinoma, is described. This was treated by ligation and excision without bypass grafting. The clinical features are discussed and the literature reviewed.
Further evidence for the effect of passive smoking on neonates
Authors: Campbell M J , Lewry J , Wailoo M 
Published: December 2008

Summary
From 518 couples with a 1 month old baby, information was obtained on the couple’s smoking habit, social class, age of mother, parity, alcohol consumption during pregnancy and respiratory symptoms of the baby. Allowing for these factors, a multivariate analysis revealed that, even allowing for mother’s smoking habit, babies whose father smoked were lighter at birth by an average of 113 g (95% CI 8-216 g) and this effect was unchanged at 1 month (112 g, 95% CI 0-224 g). Babies whose mothers smoked were twice as likely to have a cough (Relative Risk = 2.0, 95% CI 1.05-3.68), than those whose mothers did not, but we failed to find a significant association with the father’s smoking habit.
The efficiency and effectiveness of geriatric day hospitals
Authors: Zeeli D , Isaacs B 
Published: December 2008

Summary
One hundred patients who were referred consecutively to two geriatric day hospitals were followed for 3 months, to determine the efficiency and effectiveness of day hospital management. Transport was highly efficient; only one in every 40 attendances failed because of transport. Selection of patients may have been less efficient, in that only half completed planned treatment. In most cases this was because of progression of the illness. Time at the day hospital was on the whole efficiently used, in that three-quarters of the time was devoted to programmed activities. The effectiveness of the day hospital was limited. In only about one-third of referred patients were the objectives set by the doctor attained. Likewise only one-third of patients felt that they had improved, and one-third of carers experienced relief of strain.
The haematology of hyperthyroidism: abnormalities of erythrocytes, leucocytes, thrombocytes and haemostasis
Authors: Ford H C , Carter J M 
Published: December 2008

SummaryThe abnormalities of erythrocytes, leucocytes, thrombocytes and coagulation that have been reported, particularly in more recent years, to be associated with hyperthyroidism are surveyed. Several areas are highlighted where further investigations could lead to clinically useful insights, improved information about the haematological processes involved or to a better understanding of thyroid hormone action.
Management of acute liver failure
Authors: Williams R 
Published: December 2008

Summary
The principles of management for acute liver failure are: 1. Accurate diagnosis of the type--fulminant, late onset, acute on chronic--and establishment of likely aetiology. 2. Early detection and treatment of complications, particularly metabolic acidosis (early), renal failure, cerebral oedema and infections (late). 3. Optimization of conditions for regeneration by maintenance of normal metabolic milieu (? removal of toxins). 4. Early consideration of an orthotopic liver transplant for poor prognosis group.
Delayed tension pneumothorax complicating staphylococcal pneumonia
Authors: Yates S P , Morcos S K 
Published: December 2008

Summary
A case is described in which a tension pneumothorax complicated staphylococcal pneumonia 11 months after its onset. The delayed and subacute/chronic nature of the tension pneumothorax is unusual. The case also highlights the difficult differential diagnosis between subpleural lung cysts and encysted pneumothorax.
Gastric adenocarcinoma associated with adenomyoma of the stomach
Authors: Chapple C R , Muller S , Newman J 
Published: December 2008

Summary
We report a case of gastric adenomyoma contiguous with adenocarcinoma of the stomach. Although a similar association is well recognized in the duodenum, we believe this to be the first documented case in the stomach. We review the literature on adenomyomata and discuss the implications of this finding. It would appear that glandular and cystic intramural lesions of the stomach are a heterogeneous group, and while there is a well established association between gastric carcinoma and gastritis cystica profunda, the same does not apply to gastric adenomyoma.