bluuebunny/crossref_metadata_2025_split huggingface dataset:
Raised blood urea in the elderly: a clinical and pathological study
Authors: Bowker Lesley K , Briggs R S J , Gallagher P J , Robertson Dorothy R C 
Published: December 2008

Summary
We have attempted to define a normal range for blood urea and creatinine for elderly inpatients and to determine the relative importance of pre-renal, renal and post-renal pathology in those with renal impairment. A total of 118 admissions to an acute geriatric unit and 67 separate post mortems in patients over 67 years of age were studied prospectively. Up to 123 items of data were coded and analysed including blood urea and creatinine, clinical or pathological changes associated with renal disease, clinical outcome and post mortem findings. We determined our own 'normal' hospital ranges for urea (1.4-13.2 mmol/l) and creatinine (48-141 mumol/l) from plasma values in 76 patients with no evidence of renal impairment, either on admission or in the past. Using these values 41% of post mortem cases and 25% of clinical admissions had a raised blood urea. Pre-renal conditions such as cardiac failure, dehydration and gastrointestinal haemorrhage, either alone or in combination, were present in 56% of these patients. Urea and creatinine values were substantially higher in patients who died in hospital as opposed to those who were discharged or transferred. Creatinine values were greater in those with intrinsic renal disease or post-renal obstruction as compared to patients with pre-renal causes of renal impairment. Patients with histological evidence of extensive glomerulosclerosis or nephrosclerosis had higher urea and creatinine levels than those with only minor ageing changes.
Hypertension in aortic valve disease and its response to valve replacement
Authors: Zezulka Alexander , Mackinnon John , Beevers D G 
Published: December 2008

Summary
We have investigated the prevalence of hypertension and the response of blood pressure to operation in 87 patients with lone aortic valve disease who underwent aortic valve replacement.
In patients with aortic stenosis alone 26% were hypertensive pre-operatively (age and sex adjusted blood pressure greater than 160 systolic and or greater than 95 mmHg diastolic) and 24% were hypertensive post-operatively. In those with aortic regurgitation alone, hypertension was present in 65% before and 57% after valve replacement using the same criterion. For combined stenosis and regurgitation, the prevalence was 54% and 62%, respectively.
The post-operative increase in systolic pressure in patients with aortic stenosis occurred mainly in those with a history of left ventricular failure. In those with aortic regurgitation or combined stenosis with regurgitation, diastolic pressure rose after valve replacement resulting in a prevalence of diastolic hypertension of 44% and 35%, respectively. Blood pressure changes were not predicted by the type of valve inserted nor its size.
Our data show that despite severe symptomatic aortic valve disease, systolic hypertension was common in aortic stenosis and diastolic hypertension was found in aortic regurgitation. This underlines the importance of blood pressure monitoring in patients following aortic valve replacement.
Glomerulonephritis associated with antibodies to neutrophil cytoplasm and glomerular basement membrane
Authors: McCance D R , Maxwell A P , Hill Claire M , Doherty C C 
Published: December 2008

Summary
The prognosis for recovery of renal function of oligoanuric patients with anti-glomerular basement membrane disease is generally regarded as poor. Five patients are reported with dialysis-dependent renal failure in whom antibodies were present simultaneously both to neutrophil cytoplasm and glomerular basement membrane all of whom responded, at least initially, to immunosuppressive therapy and plasma exchange. Two of the 5 remain in clinical and immunological remission at 25 and 51 months of follow-up. We suggest that reversal of dialysis-dependent renal failure may be possible in some patients who display this dual antibody positivity.
Androgen-producing bilateral large cortical adrenal adenomas associated with polycystic ovaries in a young female
Authors: Micić D , Zorić S , Popović V , Janković R , Jancić M , Han R , Manojlović D , Mićić J 
Published: December 2008

Summary
An association of bilateral large adrenocortical androgen-producing adenomas with polycystic ovaries in a young female is presented. She developed mild hirsutism and secondary amenorrhoea at the age of 17, and was treated for 3 years with an anti-androgen (cyproterone acetate) and ethinyloestradiol. Routine follow-up at the age of 21 showed bilateral large adrenal tumours and polycystic ovaries, together with high serum testosterone and dehydroepiandrosterone sulphate values. Bilateral adrenalectomy was performed, which resulted in lowering of the elevated androgens, and large bilateral adrenocortical adenomas were confirmed histologically. Contrary to expectations, the polycystic appearance of the ovaries persisted after adrenalectomy.
This case supports the possible role of adrenal androgens in the pathogenesis of polycystic ovaries as well as the possibility of the persistence of polycystic ovaries without adrenal androgens once they have developed.
Vocal cord paralysis and oesophago-broncho-aortic fistula complicating foreign body-induced oesophageal perforation
Authors: Taha A S , Nakshabendi I , Russell R I 
Published: December 2008

Summary
A 61 year old man died after presenting with a 24 h history of haematemesis and haemoptysis, and one year history of hoarseness of voice. Post-mortem examination showed a dental plate eroding through the mid-oesophagus into a bronchus and into the descending arch of the aorta, with scarring suggestive of old perforation. An organized haematoma also involved the left recurrent laryngeal nerve. Vocal cord paralysis may be a manifestation of foreign body-induced oesophageal perforation, which can lead to death from an oesophago-broncho-aortic fistula. Both complications of oesophageal perforation from a foreign body have not to our knowledge been previously reported.
Horner's syndrome in severe tetanus
Authors: Syam B , Owens D 
Published: December 2008

Summary
A 66 year old man was admitted with a left Horner's syndrome, and trismus due to tetanus. Three days later he had respiratory arrests, classical tetanic spasms and was ventilated. He had associated severe autonomic dysfunction, tachyarrhythmias, hypotension, sweating and constipation. There was complete resolution of the left Horner's syndrome with recovery from tetanus.
Metastatic cervical lymph nodes: general practitioner referral patterns
Authors: McRae Duncan , Buchanan George , Kenyon G S 
Published: December 2008

Summary
Premature excision biopsy of a cervical lymph node infiltrated by metastatic carcinoma may compromise patient survival since it is associated with an increased incidence of local wound recurrence and distant metastases. Seventy per cent of such patients have an identifiable head and neck primary, obviating the need for an excision biopsy. It is important therefore that they are examined by surgeons who are experienced in inspecting the upper aerodigestive tract and who are competent in performing definitive head and neck surgery. A questionnaire sent to all general practitioners of an Inner London and a District Health Authority revealed that only 18% and 33% respectively referred patients who they suspected of having a metastatic neck node to a department with an experienced head and neck surgeon. We conclude that greater emphasis on the correct management of these patients at both an undergraduate and postgraduate level may encourage subsequent generations of general practitioners to review their referral patterns.
'The Health of the Nation': the impact of personality disorder on 'key areas'
Authors: Norton K R W 
Published: December 2008

Summary
The purpose of this response paper is to document a form of mental illness, namely, personality disorder: (1) whose impact is far-reaching, impinging on different 'key areas' identified in 'The Health of the Nation' (The Health of the Nation: A Consultative Document. HMSO, London, 1991), including: eating and drinking habits, smoking, prevention of accidents, human immunodeficiency (HIV)/acquired immunodeficiency syndrome (AIDS), and other mental illness itself; (2) which tends to be underdiagnosed by health-care professionals in spite of its aetiological relationship to other 'key areas' (as above); (3) which tends to be associated with negative therapeutic attitude in spite of well-documented, albeit specialist, treatment expertise; (4) which, importantly, transmits psychopathology from one generation to the next and hence has a pivotal role to play in prevention; and (5) which, for the reasons enumerated above, could form a 'target' for various, measurable, interventions.
Congenital left ventricular diverticula: a rare cause of sudden cardiac death
Authors: Speechly-Dick M E , Oliver R M , Slapak G I 
Published: December 2008

Summary
Congenital left ventricular diverticula are a rare cause of sudden cardiac death. We describe the first reported case of ventricular fibrillation in association with congenital diverticula of the heart. The diagnosis of left ventricular diverticula was made by cardiac catheterization and confirmed by magnetic resonance imaging. Treatment was initiated with anti-arrhythmic and anticoagulant drugs to prevent life-threatening arrhythmias and emboli.
Addisonian crisis presenting with a normal short tetracosactrin stimulation test
Authors: Butcher Graham P. , Zambon Maria , Moss Steven , Walters Julian R.F. 
Published: December 2008

Summary
We report the case of a 70 year old man who presented with physical and biochemical features suggestive of Addison's disease, but had a normal short tetracosactrin (Synacthen) test. Six months later he re-presented with similar clinical features but with an abnormal response to tetracosactrin confirming the diagnosis of Addison's disease. We recommend that if adrenal insufficiency is strongly suggested further investigation should be performed to exclude this diagnosis.
Suprasellar ectopic pituitary adenoma presenting as cranial diabetes insipidus
Authors: Luk K. H. , Lam Karen S.L. , Kung Annie W.C. , Fung C. F. , Leung S. Y. 
Published: December 2008

SummaryWe describe the occurrence of a supracellar ectopic pituitary adenoma in a 34 year old woman who presented with cranial diabetes insipidus and subsequently developed galactorrhoea-amenorrhoea. The tumour was demonstrated by both contrast computed tomography scan and magnetic resonance imaging with gadolinium enhancement and was confirmed at operation. Histological examination showed that the suprasellar lesion consisted of a pituitary adenoma while the pituitary biopsy revealed an unrelated pituitary microadenoma embedded in normal pituitary tissues. A review is made of the reported cases of ectopic pituitary adenomas.
Sub-clinical systemic lupus erythematosus presenting with acute myocarditis
Authors: Sandrasegaran K. , Clarke C. W. F. , Nagendran V. 
Published: December 2008

Summary
A 46 year old woman presented with fever and normochromic anaemia followed rapidly by severe myocardial failure, unresponsive to maximum inotropic support and broad spectrum antibiotics. There were no classical clinical stigmata of systemic lupus erythematosus (SLE) but a possible immunological cause was looked for, and on the basis of her immuno-serology a diagnosis of SLE-like disease was made. She responded rapidly to high dose steroids. The importance of considering the possibility of SLE or 'lupus overlap' in an acutely ill 'undiagnosed' patient is emphasized. The relevance of instigating appropriate immuno-serological tests in the course of such an illness is discussed.
The evaluation of dizziness in elderly patients
Authors: Ahmad N , Wilson J A , Barr-Hamilton R M , Kean D M , MacLennan W J 
Published: December 2008

Summary
Twenty-one elderly patients with dizziness underwent a comprehensive medical and otoneurological evaluation. The majority had vertigo, limited mobility and restricted neck movements. Poor visual acuity, postural hypotension and presbyacusis were also frequent findings. Electronystagmography revealed positional nystagmus in 12, disordered smooth pursuit in 18, and abnormal caloric responses in nine. Magnetic resonance imaging showed ischaemic changes in six out of eight patients. Although dizziness in the elderly is clearly multifactorial, the suggested importance of vertebrobasilar ischaemia warrants further consideration as vertigo has been shown to be a risk factor for stroke.
Peptic oesophageal stricture: an age-related problem?
Authors: Gainsborough N , Powell-Jackson P 
Published: December 2008

Summary
A one year retrospective study of 76 patients with peptic oesophageal stricture was performed. Analysis of results showed a significant age-related risk of developing peptic oesophageal stricture. Possible age-related risk factors are discussed. Pitfalls in diagnosis and management are highlighted and the role of H2 receptor antagonists, antacids and omeprazole are discussed.
Bilateral carpal tunnel syndrome associated with interleukin 2 therapy
Authors: Heys S D , Mills K L G , Eremin O 
Published: December 2008

Summary
We report the development of synchronous bilateral carpal tunnel syndrome in a woman with metastatic colorectal cancer, undergoing treatment with recombinant interleukin 2. A carpal tunnel decompression was carried out on the hand which was more severely affected, with a gradual recovery in median nerve function. To the best of our knowledge, this is the first reported case of carpal tunnel syndrome in association with recombinant interleukin 2.
Suppurative thyroiditis with oesophageal carcinoma
Authors: Premawardhana L D K E , Vora J P , Scanlon M F 
Published: December 2008

Summary
A 68 year old, previously well woman presented with dysphagia, weight loss and a neck swelling. Investigations revealed a right-sided thyroid abscess with fistulous connection to the upper of two oesophageal carcinomas, a previously unreported association. The resistance of the thyroid to infection and the mechanisms of thyroid abscess formation in this patient are discussed.
Concentrations of vitamins A, C and E in elderly patients with Parkinson's disease
Authors: King D , Playfer J R , Roberts N B 
Published: December 2008

Summary
Concentrations of the naturally occurring antioxidant vitamins A, C and E were measured in 27 patients with Parkinson's disease and 16 age-matched control subjects, from a similarly disabled patient group. There was no significant difference in the serum concentrations of vitamins A and E in the two groups. Vitamin C was significantly higher (P &lt; 0.05) in the Parkinson's disease group, however, the mean leucocyte vitamin C concentration in the control group was low (101 nmol/10(8) WBCS) compared to established data in healthy young individuals (119-301 nmol/10(8) WBCS). There was no correlation between the severity or duration of Parkinson's disease and concentrations of vitamins A, C and E. There is therefore no evidence from this study that a deficiency of these antioxidants contributes to the onset or progress of Parkinson's disease.
Microalbuminuria in non-insulin-dependent (type 2) Nigerian diabetics: relation to glycaemic control, blood pressure and retinopathy
Authors: Erasmus R T , Oyeyinka G , Arije A 
Published: December 2008

SummaryTwenty-four hour urinary albumin concentrations were measured in 113 (mean age 51.1 years) non-insulin-dependent (NIDDM) Nigerian diabetics (50 males, 63 females). A high prevalence of microalbuminuria (&gt; or = 30 mg/24 hour) was observed in male (54%) as well as female diabetics (59%). Microalbuminuria was also observed in a high proportion of diabetics (52%) with a short duration (&lt; 5 years) of disease. Elevated blood pressure and retinopathy were present in 41% and 16% of patients respectively. Among the 49 patients with normoalbuminuria (&lt; 30 mg/24 hour), six (12%) had retinopathy compared with 12 (18%) in the microalbuminuria group. Diastolic blood pressure levels were significantly higher (P &lt; 0.01) in male diabetics with retinopathy but this was not associated with higher albuminuria. Urinary albumin concentrations were not influenced by elevated blood pressure. There were no significant differences in age, duration of diabetes, blood pressure or serum creatinine between diabetics with and without microalbuminuria. These results suggest that though there is a high prevalence of microalbuminuria amongst NIDDM Nigerian diabetics it may not predict retinopathy and occurs independently of either glycaemic control or elevated blood pressure levels.
Magnetic resonance imaging for the assessment of residual masses after treatment of non-Hodgkin's lymphomas
Authors: Montalbán Carlos , Rodríguez-García Jose Luis , Mazairas Luis , Ayala Inmaculada , Marcos-Robles Jose 
Published: December 2008

Summary
Eight patients with non-Hodgkin's lymphoma who were in clinical remission but showed residual masses after therapy were examined with magnetic resonance imaging at 1.5 T at the end of therapy, with the sequences TR/TE:500/35,500/70,2000/35 and 2000/70. Residual masses were found in lymphoid areas (7), spleen (3) and kidney (1). In three patients, T2 showed high signal intensity. Disease progressed in the following 1-3 months and active lymphoma was histologically identified. In the other five patients, T2 showed a very low signal intensity. One of them had a distant relapse in lymphoid areas but the remaining four patients are asymptomatic after a mean follow-up time of 13 months, suggesting that the lymphoma is cured and the mass inactive.
We conclude that magnetic resonance imaging seems to distinguish active from non-active residual masses after treatment of non-Hodgkin's lymphoma patients otherwise in clinical remission.
In situ demonstration of Epstein-Barr virus in intravenous drug abusers with generalized lymphadenopathy
Authors: Mampaso F , Bellas C , Molina A , Quereda C , Bricio T , Buzon L 
Published: December 2008

Summary
We have studied by the in situ hybridization method the presence of Epstein-Barr virus (EBV) DNA genome in lymph node tissues from 11 patients with persistent generalized lymphadenopathy. Using a biotinylated EBV DNA probe, we demonstrated EBV nucleic acid in scattered germinal centre cells in eight of the 11 cases. Our results suggest that EBV is not a determinant factor in the pathogenesis of this lymphadenopathy, but support its possible implication in B cell malignant transformation in cases of AIDS-associated lymphoma.
Acute myocardial infarction related to smoke inhalation and myocardial bridging
Authors: McCabe Michael J , Weston Clive F M , Fraser Alan G 
Published: December 2008

Summary
A previously healthy 26 year old woman who was exposed to smoke during a house fire developed acute anterior myocardial infarction complicated by ventricular fibrillation. Subsequent left ventriculography confirmed anterior infarction, but coronary arteriography was normal apart from myocardial bridging over a segment of the left anterior descending artery. The development of acute myocardial infarction in this patient suggests that, in the presence of bridging, carbon monoxide inhalation may cause regional infarction.
Patient recovery following cholecystectomy through a 6 cm or 15 cm transverse subcostal incision: a prospective randomized clinical trial
Authors: O'Dwyer P J , McGregor J R , McDermott E W M , Murphy J J , O'Higgins N J 
Published: December 2008

Summary
The effect of incision length on patient recovery following cholecystectomy has not been investigated previously. In this study, 30 patients with symptomatic gallstones were randomized to cholecystectomy through a 6 cm or 15 cm transverse subcostal incision. Postoperative hospital stay was significantly shorter in the 6 cm incision group (median 3 days vs 5 days; P = 0.0069 Mann-Whitney U-test). In the 6 cm group analgesic requirements were reduced (median 2.5 vs 4.5 intramuscular opiate injections per patient) and recovery of depressed postoperative pulmonary function (FVC and FEV1) was faster (3% difference between groups on day 1 and 7% on day 3), although these differences did not achieve statistical significance. These results suggest that the length of incision may influence patient recovery following elective cholecystectomy. This has important implications as surgery carried out through shorter and less traumatic incisions may offer a cost-effective alternative to laparoscopic cholecystectomy. Moreover, some surgeons may find mini-laparotomy cholecystectomy easier to adopt than laparoscopic techniques.
The effect of hemiplegia on blood pressure measurement in the elderly
Authors: Dewar R , Sykes D , Mulkerrin E , Nicklason F , Thomas D , Seymour R 
Published: December 2008

Summary
The blood pressure in both arms of 103 unselected hemiplegic patients was measured using a random-zero sphygmomanometer. Although for the whole sample the mean blood pressure in the paretic and unaffected arm was similar, a significant difference was found when the patients were subdivided according to the tone of the arm. The blood pressure was higher in paretic arms of patients with a spastic stroke and lower in the affected arm if the tone was flaccid. No other characteristics were associated with significant blood pressure differences, so that the findings appear to be directly related to changes in muscle tone. After a stroke the blood pressure should always be measured in the unaffected arm because changes in tone make measurements unreliable.
The differing predictive values of oestrogen receptor assays for large breast cancers
Authors: Gaskell D J , Hawkins R A , Tesdale A L , Sangster K , Chetty U , Forrest A P M 
Published: December 2008

Summary
Thirty elderly patients with T3 or T4 breast cancer underwent a wedge biopsy for radioligand-binding assay (RLA) of oestrogen receptor (ER) activity. A second, separate group of 21 elderly patients with T3 and T4 breast cancers underwent fine needle aspiration biopsy (FNA) for immunocytochemical assay of ER (ER-ICA). All the women received tamoxifen as primary treatment and response was assessed by UICC criteria. Tumour ER concentration by RLA was correlated with both response (Spearman's R = + 0.52) and time to progression (R = + 0.76). Nine patients with receptor-rich tumours (&gt; 100 fmol/mg protein) failed to show a response. However, the percentage of cells staining for ER by ER-ICA assay was much more strongly related to the likelihood of response (R = + 0.89); no patient with &lt; 20% cells staining responded. Wedge biopsy and the biochemical determination of ER activity is of limited value in predicting the likely response to tamoxifen; ER-ICA assays on such tumours may be more informative.