bluuebunny/crossref_metadata_2025_split huggingface dataset:
Focal myositis: an unusual cause of bilateral upper eyelid swellings
Authors: Lim K L , Robson K , Powell R J 
Published: December 2008

Summary
Focal myositis is considered a rare self-limiting inflammatory swelling of skeletal muscle. Focal involvement of individual muscle or muscle groups with severe myopathic and inflammatory changes characterizes the histology. We report the development of progressive focal myositis in both upper eyelids of a 34 year old man that responded to immunosuppressive therapy.
First use of G-CSF in chlorpromazine-induced agranulocytosis: a report of two cases
Authors: Kendra J R , Rugman F P , Flaherty T A , Myers A , Horsfield N , Barton A , Russell L 
Published: December 2008

Summary
Chlorpromazine-induced agranulocytosis is an uncommon disorder associated with a high frequency of fatality. We describe two patients with chlorpromazine-induced granulocytosis in whom granulocyte colony stimulating factor (G-CSF) administration enhanced the speed of neutrophil recovery. No toxicity was noted with G-CSF and both patients made a successful recovery. We propose there is a role for such cytokine therapy in patients with life-threatening agranulocytosis in order to speed the recovery of neutrophils.
Detection of Epstein-Barr genome in the lymph nodes of Hodgkin's disease
Authors: Bellas C , Mampaso F , Fraile G , Molina A , Bricio T , Cuesta C 
Published: December 2008

Summary
We have used the enzymatic in situ hybridization method to investigate the presence of Epstein-Barr virus (EBV) genome in lymph node tissues from patients with Hodgkin's disease. Also, 11 patients with persistent human immuno-deficiency virus-associated generalized lymphadenopathy as well as seven autopsy cases with no Hodgkin's disease, formed part of these studies.
EBV DNA-positive reaction was demonstrated in Reed-Sternberg cells and variants in seven of 16 cases and in the small accompanying lymphocyte cell population in 14 of the 16 cases. It was also found in eight of the 11 cases with persistent generalized lymphadenopathy but in none of the lymph nodes from negative selective autopsy cases.
Our results indicate that the colorimetric in situ hybridization technique is useful in EBV nucleic acid detection and cell-type localization in Hodgkin's disease. Additionally, the detection of EBV genome, not only in the diagnostic cells but in the small lymphocyte cell components, could provide new insights into the potential role of this agent in the pathogenesis of Hodgkin's disease.
Control of plasma glucose with somatostatin analogue (SMS 201-995) during surgical removal of insulinomas
Authors: Utas C , Kelestimur F , Boyaci A , Saglam A 
Published: December 2008

Summary
Prevention of hypoglycaemia may sometimes be difficult in the operative period of insulinoma when parenteral volume overload is contraindicated due to severe cardiac failure. We investigated the effects of octreotide on hypoglycaemia during operations in two patients with insulinoma, one of whom had severe congestive heart failure. We found no hypoglycaemic values by using octreotide 100 micrograms administered subcutaneously one hour before surgery. Octreotide therapy can safely be used before surgery to prevent hypoglycaemia in patients with insulinoma.
The use of midazolam and flumazenil for invasive radiographic procedures
Authors: Roberts S P , Hargreaves J , Pollard B J 
Published: December 2008

Summary
This study has examined the use of flumazenil to improve recovery following sedation with midazolam in elderly patients undergoing invasive radiological procedures. Forty patients received either flumazenil or placebo in a randomized double-blind fashion following midazolam sedation. Nalbuphine 10-15 mg was given for premedication. All but one of the patients in the flumazenil group were fully awake immediately following the reversal agents compared to only one in the placebo group (P = 0.016). This statistically significant difference remained after 20 minutes (P = 0.029). There were no adverse effects on heart rate, blood pressure, forced expiratory volume in one second, vital capacity or oxygen saturation. The majority of patients (78% overall) could not recall their procedure. All patients said that they would be willing to undergo a similar technique in the future.
Unusual manifestations of craniofacial fibrous dysplasia: clinical, endocrinological and computed tomographic features
Authors: Daly B D , Chow C C , Cockram C S 
Published: December 2008

Summary
Clinical, endocrinological and computed tomographic features of three patients with unusual manifestations or complications of craniofacial involvement of fibrous dysplasia are presented. One patient with polyostotic fibrous dysplasia presented in late pregnancy with acute onset of bilateral optic nerve compression and blindness secondary to a rapidly expanding mass of fibrous dysplasia tissue involving the sphenoid, pituitary and optic chiasm regions. A second patient with polyostotic fibrous dysplasia developed thyrotoxicosis and probable gigantism/acromegaly in keeping with a rare form of McCune-Albright syndrome. Extensive bony distortion of the skull and facial bones by fibrous dysplasia made clinical recognition of these complications more difficult. A third patient had monostotic fibrous dysplasia with marked sclerosis of the sphenoid bone on plain radiographs which mimicked appearances of a meningioma and resulted in a negative craniotomy as computed tomography was not yet available at the time of presentation.
Each case demonstrated rare complications of craniofacial fibrous dysplasia and highlighted the wide spectrum of appearances in which it may manifest, often resulting in overlap and diagnostic confusion with other disease processes. The value of computed tomography in assessment is emphasized.
Persistent monoarthritis and occult coeliac disease
Authors: Borg A A , Dawes P T , Swan C H J , Hothersall T E 
Published: December 2008

Summary
Arthritis is a recognized complication of untreated coeliac disease. Symptoms and signs usually respond to the institution of a gluten-free diet. We report a case of occult coeliac disease presenting as a monoarthritis. Severe and progressive erosive damage has occurred in his talo-navicular joint despite a response to the institution of a gluten-free diet.
Cardiac involvement (Wolff-Parkinson-White syndrome) in tuberous sclerosis
Authors: Ijaola Olajide , Festus-Abibo L C , Lawani Olu , Kuku Sonny F 
Published: December 2008

Summary
A surface electrocardiogram showing type B Wolff-Parkinson-White syndrome pattern was part of the cardiac findings in a female of 24 with florid features of tuberous sclerosis. She had cardiomegaly but no intracardiac tumour was demonstrated. Wolff-Parkinson-White syndrome, though rare, has previously been described in association with tuberous sclerosis in children but not before in adults.
Chronic active hepatitis in the type I polyglandular autoimmune syndrome
Authors: Michele Theresa M , Fleckenstein Jacqueline , Sgrignoli Anita R , Thuluvath Paul J 
Published: December 2008

Summary
Type I polyglandular autoimmune syndrome is characterized by the triad of hypoparathyroidism, Addison's disease and chronic mucocutaneous candidiasis. Chronic active hepatitis has been associated with this syndrome but its incidence and severity have not been well documented.
We describe a sibship of two patients with type I polyglandular autoimmune syndrome who presented with autoimmune chronic active hepatitis. The first patient presented to us with advanced disease and died despite an emergent liver transplant, while the second patient responded to steroids.
Autoimmune chronic active hepatitis, a major cause of mortality in this syndrome, can present without symptoms or physical signs of liver disease. We suggest periodic screening of liver enzymes in subjects with this syndrome.
Consultant views on the use of aspirin in acute cerebrovascular disease: implications for clinical trials
Authors: Kent James , Bamford John 
Published: December 2008

Summary
A questionnaire was sent to all 155 consultant physicians and geriatricians in the Yorkshire region who routinely admit patients with acute stroke in order to ascertain: (a) current opinion regarding the prescription of aspirin to patients with various manifestations of cerebrovascular disease, in particular the timing of initial treatment; and (b) the perceived role of computed tomography (CT) scans in relation to such therapy.
The response rate was 81% (126/155). Aspirin was reported to be prescribed routinely by 75% (95/126) of physicians for patients with completed stroke. Amongst those prescribing aspirin, treatment was reported to be initiated routinely within 48 hours of the onset of symptoms by 63% (60/95). Only 10% (6/60) of these physicians reported that they would withhold aspirin therapy until the result of a cranial CT scan was known, although 43% (26/60) thought a CT scan was desirable.
Our survey, which for logistical reasons is one of opinion rather than actual practice, suggests that aspirin is probably being prescribed acutely (less than 48 hours) after stroke to a significant number of patients and often without a pretreatment CT scan. As with patients who have had a CT scan, the balance of risks and benefits of this practice are unknown. We conclude that it would be ethical for acute treatment trials to allow randomization to aspirin without prior CT scan.
A comparison of intravenous and subcutaneous hydration in elderly acute stroke patients
Authors: Challiner Yvonne C , Jarrett D , Hayward M J , al-Jubouri M A , Julious S A 
Published: December 2008

Summary
The aim of this study was to compare the effectiveness of subcutaneous and intravenous fluid therapy in hydrating, elderly acute stroke patients. Thirty-four such patients, needing parenteral fluids because of impaired consciousness or dysphagia, were randomly allocated to receive either subcutaneous or intravenous fluids (2 litres of dextrose-saline/24 hours). Serum osmolality was measured before starting fluid therapy (Day 1) and on Days 2 and 3. An analysis of covariance of the osmolalities showed no statistical difference between the two groups (P = 0.12). The total cost of cannulae used over the 3 days for the subcutaneous route was approximately a third of that for the intravenous route. Complication rates were similar for the two groups. The results suggest that subcutaneous fluid therapy is an effective alternative to the intravenous route.
Glossopharyngeal schwannoma presenting as gagging dysphagia
Authors: Tay H L , Swanston A R , Lumley J S P 
Published: December 2008

Summary
A case of cervical glossopharyngeal schwannoma presenting with gagging dysphagia is presented. Treatment was by total excision of the schwannoma following which the patient made a good recovery. To our knowledge, this is the first report of gagging dysphagia associated with a glossopharyngeal schwannoma.
A case of isolated TSH deficiency presenting as infertility
Authors: Balen Adam H , Manning Patrick J 
Published: December 2008

Summary
We report a case of late-onset isolated thyroid stimulating hormone deficiency in a woman who presented with oligomenorrhoea and secondary hyperprolactinaemia. Hypothalamic and pituitary radiology and function was otherwise normal. The underlying aetiology of this condition is thought to be due to an inborn defect in the thyrotroph and treatment is with standard thyroid replacement therapy.
Bacterial oesophagitis in an immunocompromised patient
Authors: Radhi Jasim M , Schweiger Franzjosef 
Published: December 2008

Summary
Bacterial oesophagitis is an uncommon and poorly described entity affecting particularly the immunosuppressed patient. The diagnosis rests on the demonstration of bacterial invasion of the oesophageal wall in the absence of other pathological processes. The causative organisms usually are Gram-positive cocci and there may be associated bacteraemia. The case report describes a leukaemic patient with bacteraemic bacterial oesophagitis.
Haemodynamic management in ruptured abdominal aortic aneurysm
Authors: Brimacombe J , Berry A 
Published: December 2008

Summary
Ruptured abdominal aortic aneurysm currently accounts for about 1 in 200 deaths and is a critical surgical emergency with an average hospital mortality of 50%. The combination of acute massive haemorrhage in an elderly patient with pre-existing medical disease is highly lethal and a major challenge for any health care system. This article outlines the general principles of management and discusses the problems of haemodynamic assessment and preclamping fluid resuscitation.
Pharmacokinetics of naftopidil, a novel anti-hypertensive drug, in patients with hepatic dysfunction
Authors: Farthing M J G , Alstead E M , Abrams S M L , Haug G , Johnston A , Hermann R , Niebch G , Ruus P , Molz K H , Turner P 
Published: December 2008

Summary
The pharmacokinetics of naftopidil, a novel alpha-1 adrenoceptor-blocking antihypertensive, were investigated in ten patients (9M/1F) with hepatic dysfunction after oral administration (50 mg, tablet) and after an intravenous infusion of 5.0 mg over 2 minutes. Results were compared to a control group of 12 healthy subjects (6M/6F) of a previous investigation, which was carried out according to the identical study protocol.
The pharmacokinetic parameters obtained for the i.v. administration were comparable in both groups (half life 3.6 +/- 3.4 hours in liver-impaired subjects versus 3.3 +/- 2.1 hours in controls; clearance 11.9 +/- 4.7 ml/minute/kg versus 11.0 +/- 1.6 ml/minute/kg).
Following oral administration the plasma levels and half-life times of naftopidil were significantly increased in liver impairment (t1/2 16.6 +/- 19.3 hours versus 5.4 +/- 3.2 hours in controls; P = 0.012). Mean values for the absolute bioavailability in patients with hepatic dysfunction were significantly higher (mean 75%, median 53%, range 13.4-211.0%) compared to healthy subjects (mean 17%, median 16%, range 6.7-29.6%, P = 0.001).
Reduction of functional hepatic blood flow in chronic liver disease or, as evidenced in one case as a consequence of shunt surgery, is the probable cause of the observed alteration in naftopidil kinetics. This phenomenon occurred only following the oral 50 mg dose whereas the intravenous 5 mg dose obviously still could be normally handled. Naftopidil demethylation and hydroxylation were both less and non-uniformly affected.
The pharmacokinetic findings suggest that in patients with severe hepatic impairment or evidence for marked changes in hepatic blood flow the dose of naftopidil may require adjustment to the lower end of the therapeutic range and/or may be limited to once daily. However, before definite conclusions can be drawn, further steady-state studies are required. Despite the pharmacokinetic discrepancies no difference in drug tolerability was seen between patients and healthy subjects.
Duodenal plasmacytoma: a rare extramedullary localization simulating carcinoma of the head of the pancreas
Authors: Schoretsanitis G , Livingstone J I , el-Japour J N , Watkins N , Wastell C 
Published: December 2008

Summary
Plasmacytomas occurring in extramedullary sites are rare tumours, particularly so when located in the gastrointestinal tract. We report the case of a solitary extramedullary plasmacytoma arising in the duodenum and simulating a carcinoma of the head of the pancreas. Diagnostic and treatment options are discussed.
Retroperitoneal lymphadenopathy: an extrahepatic feature of chronic active hepatitis
Authors: Hayek Tony , Markel Arie , Goldfeld Moshe , Ben-Arie Yehudit , Brook Gerald J 
Published: December 2008

Summary
We report a patient with chronic active hepatitis in whom one of the initial findings was retroperitoneal lymphadenopathy, detected by abdominal ultrasound examination. Extrahepatic presenting findings of chronic active hepatitis may include arthritis, urticaria, pleurisy and pericarditis, while abdominal lymphadenopathy has been only rarely described. Chronic active hepatitis should be included in the differential diagnosis of abdominal lymphadenopathy.
The changing clinical spectrum of liver abscess: the Jerusalem experience
Authors: Yinnon A M , Hadas-Halpern I , Shapiro M , Hershko C 
Published: December 2008

Summary
A retrospective study was conducted of all 31 patients with liver abscess admitted to Shaare Zedek Medical Center between 1979, the year computed tomographic scan and ultrasound were introduced, and 1992. Fever and abdominal pain were the most common symptoms. Duration of symptoms was short: 81% of patients had symptoms for &lt; or = 5 days and none had symptoms for more than 3 weeks. Amoebic abscess was found in one patient only, the remainder were pyogenic. Biliary tract pathology remains the most common cause of liver abscess (39%). The diagnosis was made by ultrasound in 22/31 (71%) and by computed tomographic scan in 9/31 (29%) of patients. Treatment consisted of intravenous antibiotics and percutaneous drainage under ultrasound guidance in 24/31 patients (77%). Four patients died (13%), three of whom had underlying malignancies.
Clinical features were compared with those from a similar series of 36 cases with liver abscess reported from Jerusalem predating ultrasound and computed tomographic scan (1967-1977). Several major changes have occurred. First, the relative incidence of amoebic abscess has dramatically decreased. Second, ultrasound and computed tomographic scan have facilitated earlier diagnosis and percutaneous drainage, contributing to improved survival and lower morbidity.
Pituitary apoplexy after stimulation tests
Authors: Vassallo Michael , Rana Zubair , Allen Steve 
Published: December 2008

Summary
Pituitary apoplexy occurs after infarction of a non-neoplastic pituitary or sudden expansion of an adenoma following haemorrhage or infarction. It usually occurs spontaneously but can follow a number of causes including pituitary stimulation tests. Since this complication is potentially life-threatening, the benefits of subjecting patients who might have pituitary tumours to such tests should be considered.
Systemic amyloidosis and ovarian carcinoma
Authors: Fernandez-Miranda C , Mateo S , Gonzalez-Gomez C , Ballestin C 
Published: December 2008

Summary
A case of ovarian carcinoma and systemic amyloidosis in a 64 year old woman with nephrotic syndrome is reported. Immunohistochemical study of renal and rectal biopsy specimens revealed the presence of amyloidosis AA antigens, consistent with secondary amyloidosis. The absence of chronic inflammatory or infectious disease suggested the presence of a neoplasm. The gynaecological sonogram showed a solid mass located behind the uterus. Laparotomy confirmed a poorly differentiated ovarian carcinoma. The association of systemic amyloidosis and ovarian carcinoma has not to our knowledge been described previously.
Secondary polycythaemia associated with bilateral renal lymphocoeles
Authors: Burton I E , Sambrook P , McWilliam L J 
Published: December 2008

Summary
A patient with a 15 year history of secondary polycythaemia due to renal erythropoietin hypersecretion is presented. Subsequent spontaneous development of bilateral renal lymphocoeles, which contained high erythropoietin levels, was shown by computerized tomography. The lymphocoeles were successfully treated by bilateral peritoneal marsupialization. No cause for the persistent polycythaemia or lymphocoeles was found at laparotomy or on renal biopsy.
Prevalence of antibodies to hepatitis C virus after blood transfusion in heart surgery
Authors: Barcena R , Gonzalez A , Martin-de-Argila C , Ulibarrena C , Graus J , Grande L A Gil 
Published: December 2008

Summary
We studied the frequency and time of appearance of antibodies to the hepatitis C virus (HCV) retrospectively in the sera of 127 patients who underwent heart surgery between 1983 and 1986. They received blood from volunteer donors hepatitis B surface antigen (HBsAg) negative with normal serum alanine-aminotransferase levels. A prospective follow-up was carried out every 15 days for at least 6 months from the moment of the transfusion.
Of the ten patients who developed biochemical criteria of post-transfusional non-A non-B hepatitis, six seroconverted to anti-HCV (60%). Of the other 117, two were already positive before transfusion (1.51%), one patient showed antibodies only in the first post-transfusional serum (passive transfer), and another two patients with no evidence of post-transfusional hepatitis developed HCV antibodies on the 90th day, remaining indefinitely (afterwards seroconversion without hepatitis); both patients' earlier sera were anti-HCV negative.
Four (40%) of the ten patients with post-transfusional hepatitis did not develop any serum markers to known hepatotropic agents. Although these findings do not exclude a viral infection by these viruses, they are consistent with the involvement of an unidentified non-A, non-B, non-C agent.
Recurrent chylothorax in a woman with primary amenorrhoea
Authors: Sridhar Mangalam , Boyle Iain , Banham Stephen 
Published: December 2008

Summary
A 47 year old woman receiving oestrogen replacement therapy for primary amenorrhoea presented with recurrent chylothorax. The clinical and radiological features of her illness were characteristic of pulmonary lymphangio-leiomyomatosis, a rare hormone-dependent disease. The condition was treated with pleurodesis and withdrawal of oestrogen therapy.
Continuing clinically severe vitamin D deficiency in Asians in the UK (Leicester)
Authors: Iqbal S J , Kaddam I , Wassif W , Nichol F , Walls J 
Published: December 2008

Summary
Deprivational vitamin D deficiency began to be noted in immigrant Asians in the early 1960s. Although there have been suggestions that the level of this problem may be declining, we describe a number of clinical cases seen over a consecutive 3 1/2 year period. Musculoskeletal symptoms were the commonest though there were a variety of medical presentations requiring hospital referral. Most of the cases were Hindu vegetarians. There is likely to be significant underdiagnosis of this condition.
In spite of the extensive medical, social and political attention this condition has received, our study shows that vitamin D deficiency continues to persist in certain Asians in a clinically florid fashion. An effective preventative policy is long overdue.
Microembolism from aortic aneurysm and ventricular thrombus: a complication of intravenous streptokinase
Authors: Abraham John S , Wilson Moira , Scripcariu Viorel , Barnes Peter C , Marcuson Roger W 
Published: December 2008

Summary
Two patients sustained the rare complication of skin infarction following administration of intravenous streptokinase for acute myocardial infarction. We report evidence that dissolution of thrombus from an unsuspected source and subsequent microembolization of the skin may be responsible for this complication. In patients known to have an aortic aneurysm or ventricular thrombus, careful consideration should be given to the use of intravenous streptokinase following myocardial infarction.
Aggressive management of doxorubicin-induced cardiomyopathy associated with 'low' doses of doxorubicin
Authors: Sriskandan S , O'Brien M E R , Smith I E , Collins P , Gore M E 
Published: December 2008

Summary
There is a dose-effect relationship between doxorubicin and the incidence of symptomatic cardiac failure. It is generally thought that doses below 500-550 mg/m2 are safe but, when objective measures of cardiac function are used, it becomes apparent that degrees of cardiac failure occur at doses below this. We present here the case histories of two patients who developed very severe cardiac failure at cumulative doses well below 500 mg/m2 but who survived their initial cardiac illness due to aggressive intervention. In one case, the patient was successfully treated by orthotopic cardiac transplantation.