bluuebunny/crossref_metadata_2025_split huggingface dataset:
Renal hypouricaemia in a patient with 48, XXYY syndrome
Authors: Nakajima H , Tajima K , Nakajima T , Iida S , Sumi S , Kono N , Moriwaki K , Nonaka K , Tarui S 
Published: December 2008

Summary
Studies on hypouricaemia observed in a patient with 48, XXYY syndrome revealed an abnormality in renal urate handling. His renal urate clearance was abnormally increased. Inosine administration and provocative tests using probenecid and pyrazinamide identified an isolated renal tubular abnormality with increased urate secretion. Since the serum urate in his brother with a normal sex chromosome constitution was also low, the association of renal hypouricaemia and 48, XXYY syndrome in this patient is probably coincidental. Although the brother was not investigated, these siblings may be a previously unreported case of familial hypouricaemia due to isolated renal hypersecretion.
Parkinsonism induced by a monoamine oxidase inhibitor
Authors: Gillman M A , Sandyk R 
Published: December 2008

Summary
A parkinsonian syndrome developed 5 weeks after administration of phenelzine in a 42 year old woman with major depressive illness. Discontinuation of this agent resulted in gradual disappearance of the extrapyramidal syndrome. Possible underlying mechanisms for this unusual case are discussed.
Management of ventricular arrhythmias associated with mitral valve prolapse by combined alpha and beta blockade
Authors: Butrous G S , Maltz M B , O'Keefe J , Banim S O , Camm A J 
Published: December 2008

Summary
Ventricular arrhythmias are common in patients with mitral valve prolapse. Ten patients with echocardiographically confirmed mitral valve prolapse and documented ventricular arrhythmias were included in this study. The aim was to assess the value of combined alpha- and beta-blockade (labetalol) compared with beta-blockade alone (propranolol) in the management of ventricular arrhythmias in these patients. The study was performed using physiological stress, such as the Valsalva manoeuvre, isometric exercise and treadmill exercise, to initiate ventricular arrhythmias before and after intravenous propranolol or labetalol and to document arrhythmias during 24 hour electrocardiography before and after oral medication. Labetalol and propranolol decreased the heart rate and blood pressure response to these manoeuvres to a similar extent but labetalol was more effective in the control of the ventricular arrhythmias. These findings suggest that alpha adrenergic receptors may play a role in the pathogenesis of the ventricular arrhythmias in mitral valve prolapse syndrome and that labetalol offers an alternative treatment for the management of this condition.
General practice and teaching hospital use of barium meal examinations in the City and Hackney Health District
Authors: Conry B G , McLean A M , Farthing M J G 
Published: December 2008

Summary
The value of barium meal examination in the management of younger patients with dyspepsia has been seriously questioned as diagnostic yield is reported to be low with only minor abnormalities detected. Our 9 month survey of general practice and hospital out-patient use of barium meal examination in the City and Hackney Health District during 1983–84 shows that 51% of patients investigated were &lt; 50 years and 20% &lt; 30 years of age, suggesting that clinicians have not heeded these warnings. However, 30% of the younger patients had barium meal mucosal abnormalities. Over all age groups abnormalities were more prevalent in men and in general practice rather than hospital out-patient referrals (59% vs 45%; P &lt; 0.02). Previous studies may therefore have underestimated the prevalence of barium meal abnormalities in younger patients, and continued use of this examination in such patients may indicate that clinicians have found the results helpful in patient management.
Acute polyradiculoneuropathy complicating systemic lupus erythematosus
Authors: Morgan S H , Kennett R P , Dudley C , Mackworth-Young C , Hull R , Hughes G R V 
Published: December 2008

Summary
Two elderly patients with systemic lupus erythematosus (SLE) are presented. Both developed an acute polyradiculoneuropathy which is an unusual complication of this disease. Features of their presentation are discussed.
Fifteen year survival of patients presenting with hypertension to a hospital clinic
Authors: Bulpitt C J , Bulpitt P F , Daymond M , Hartley K , Dollery C T 
Published: December 2008

Summary
The survival has been determined for the 404 patients who presented to the Hammersmith Hospital Hypertension Clinic during the years 1962 to 1966 and in whom the untreated blood pressure was known. The fifteen year survival ranged from 72% for young men aged 30–49 at presentation to 27% for men aged 60–69. Sixty-eight percent of the deaths were cardiovascular or renal, 33% of all deaths were from ischaemic heart disease (IHD), 17% from stroke and 3% from renal causes. Death from any cause was predicted with statistical significance by age, the presence of accelerated or malignant hypertension, impaired renal function, smoking at presentation and systolic blood pressure. Death was not predicted by hypokalaemia, hyperuricaemia (after adjusting for renal function) and obesity.
Low dose maintenance treatment with cimetidine in duodenal ulcer: intermediate-term results
Authors: Bardhan K D , Hinchliffe R F C , Bose K 
Published: December 2008

Summary
Ulcer relapse rates during up to 2 years of prophylactic low-dose maintenance therapy (LDMT) with cimetidine 400 mg at bedtime was examined in 261 patients. Endoscopy was repeated every 6 months if asymptomatic, or whenever symptoms recurred. Relapse was defined as the recurrence of an ulcer crater or erosions or both.
In patients with non-refractory duodenal ulcer (those healed within 3 months) who comprise the majority, their likelihood of relapse at 6, 12, 18 and 24 months was: symptomatic 8%, 13%, 18%, 20%; silent 14%, 28%, 38%, 43%, respectively. In contrast, in patients with refractory ulcer, their symptomatic relapse rates were 36%, 45%, 46%, 48%, and silent 28%, 38%, 46%, 48% respectively. The outcome of a second course of LDMT was similar to the first. Narrowing the definition of relapse to exclude recurrence of erosions alone but without an ulcer decreased asymptomatic relapse in non-refractory ulcer patients by about half. No patient had any major side effects.
Thus, LDMT is a safe and effective way of keeping most patients with duodenal ulcer symptom free over 2 years.
Impaired thyrotrophin secretion following the administration of thyrotrophin-releasing hormone in type II diabetes mellitus
Authors: Small M , Cohen H N , MacLean J A , Beastall G H , MacCuish A C 
Published: December 2008

Summary
Serum thyrotrophin has been measured before and after the intravenous administration of 200 micrograms of thyrotrophin-releasing hormone in 91 white subjects (33 stable diabetic patients and 58 healthy controls), none of whom had any clinical evidence of thyroid or pituitary dysfunction. Seven of the diabetic subjects failed to achieve a rise of serum thyrotrophin of &gt; 2 mU/l above basal concentrations, as compared with only one of the control subjects (P = 0.006). The difference in response between diabetics and controls was confined to patients with Type II (non-insulin-dependent) diabetes: thus 5 of 13 Type II patients and 2 of 20 Type I (insulin-dependent) patients failed to show a normal response to thyrotrophin releasing hormone injection. No significant effect of glycaemic control on thyrotrophin responses was noted.
These results suggest that Type II diabetes mellitus may be a cause of impaired thyrotrophin secretion in patients with no clinical evidence of pituitary disease. The mechanism for this impaired pituitary hormone release remains to be clarified.
Autoimmune thyroid disease with ulcerative colitis
Authors: Modebe O 
Published: December 2008

SummaryTwo cases of co-existing thyroid disease and ulcerative colitis are reported. Thyroid disorder preceded ulcerative colitis in each case. The presence of acute colitis delayed and obscured the clinical diagnosis of thyrotoxicosis in one case and the colitis could not be controlled until her thyrotoxicosis was treated. Although the specific factors involved in this relationship are now known, an interplay of immunological factors is most probable.
Evolution of hypothyroidism in familial goitre due to deiodinase deficiency: report of a family and review of the literature
Authors: Hirsch H J , Shilo S , Spitz I M 
Published: December 2008

Summary
We studied two sisters who developed large non-toxic goitres in adolescence. Deiodinase deficiency was diagnosed by a rapid thyroid uptake of radioactive iodine (RAI) at 2 hours associated with a marked fall in thyroidal 131I by 24 hours. Serial RAI scans in the second patient documented evolution of the iodine-deficient state. Conservation of intra-thyroidal iodine stores was maintained by avid iodine uptake and failure to release organified 131I. With progressive loss of inorganic iodine, hypothyroidism developed, associated with a rise in serum TSH which further exacerbated the loss of iodine. Treatment with l-thyroxine resulted in an improvement of thyroid function, but normalization was achieved only after small doses of Lugol's iodine were administered.
These studies illustrate the variable nature and late onset of an inborn error of thyroid metabolism. This family supports an autosomal recessive mode of inheritance for deiodinase deficiency. We have documented progression from a euthyroid to hypothyroid state resulting from decompensation of iodine conservation mechanisms.
Obstruction is unimportant in the pathophysiology of hypertrophic cardiomyopathy
Authors: Criley J M , Siegel R J 
Published: December 2008

Summary
There has been a longstanding controversy about the significance of intracavitary pressure gradients in hypertrophic cardiomyopathy (HCM). It has been generally assumed that the gradient is the result of an ‘obstruction’ that impedes left ventricular outflow and which can be relieved by operative intervention. In the first decade after the discovery of HCM (1957–66), the site of ‘obstruction’ was thought to be a muscular sphincter or contraction ring in the submitral region of the left ventricle, and operations designed to emulate pyloromyectomy (for hypertrophic pyloric stenosis) were developed. Following a challenge to the existence of the ‘contraction ring’ and an alternative non-obstructive explanation of the pressure gradient, the site of ‘obstruction’ was translocated to a point of apposition between the anterior mitral leaflet and the interventricular septum, a result of systolic anterior motion (SAM) of the mitral valve. Despite the translocation of the site and mechanism of ‘obstruction’, the operation for ‘relief of obstruction’ has not changed significantly. The newer site of ‘obstruction’ has been challenged on the grounds that the ventricle is not demonstrably impeded in its emptying; when a gradient is provoked, the ventricle empties more rapidly and more completely than it does without a gradient. In addition to a non-obstructive explanation of the gradient, other phenomena thought to be indicative of ‘obstruction’ can be explained by rapid and complete emptying of the ventricle (cavitary obliteration). Since the morbidity and mortality of symptomatic HCM patients without pressure gradients may exceed that of patients with pressure gradients, it is suggested that ‘obstruction’ may be unimportant in the pathophysiology of HCM and attention should be focused on abnormal diastolic function and life threatening arrhythmias.
The morphological progression of viral myocarditis
Authors: Billingham M E , Tazelaar H D 
Published: December 2008

Summary
In an attempt to document the morphological progression from acute idiopathic myocarditis to end-stage dilated cardiomyopathy we studied 20 patients with a diagnosis of myocarditis who had had serial endomyocardial biopsies performed with intervals of 1 month to 2 years and whose ages varied from 6 months to 62 years. Fifteen of these patients were treated with immunosuppressive drugs for myocarditis. Ten out of 15 treated patients stabilized clinically. In the remaining 5 cases there was worsening congestive heart failure and 1 patient underwent cardiac transplantation. Of the 5 patients who did not receive immunosuppression, 2 stabilized spontaneously, and 3 developed heart failure, 2 of whom subsequently had cardiac transplants. Whether the patients received immunosuppression or not, in all cases, the inflammatory infiltrate was less but the myocardium developed significant hypertrophy with an increase in interstitial fibrosis and in 8 cases the morphological changes were those of dilated cardiomyopathy.
From the morphological standpoint of this study we have shown some evidence that dilated cardiomyopathy can be the end result of acute myocarditis. It appears that not every case of acute myocarditis progresses to dilated cardiomyopathy and that steroid treatment does not necessarily prevent progression of myocarditis to dilated cardiomyopathy.
Nocardia asteroides osteomyelitis
Authors: De Luca J , Walsh B , Robbins W , Visconti E B 
Published: December 2008

Summary
Nocardia asteroides osteomyelitis has previously been described only in acutely ill patients. It may occur as an isolated event or part of the disease spectrum of disseminated nocardiosis.
An 84 year old immune competent man with N. asteroides right tibial osteomyelitis had an unusual presentation, presumed mechanism of disease and outcome. His course affords an opportunity to review the literature on N. asteroides osteomyelitis and to discuss the unique features of his case.
Transitional cell carcinoma in an ileal conduit
Authors: Curran F T , Fuggle W J 
Published: December 2008

Summary
Following cystectomy for transitional cell carcinoma a 63 year old woman developed recurrent tumours in the upper urinary tract and ileal conduit, suggesting that malignant transitional cells can auto-implant in ileal epithelium. This phenomenon has not been previously reported. We illustrate the value of retrograde urogram via an ileal conduit following cystectomy for cancer.
Extracorporeal membrane oxygenation as emergency treatment for life-threatening acute severe asthma
Authors: King D , Smales C , Arnold A G , Jones O G 
Published: December 2008

Summary
We report a case of acute severe asthma that was resistant to full medical treatment, mechanical ventilation and halothane inhalation. Because a fatal outcome appeared likely extracorporeal membrane oxygenation, involving partial cardiac bypass, using femoral artery and femoral vein cannulation was instituted as an urgent measure. The patient then made a satisfactory recovery.
Spontaneous spinal epidural haematoma with spontaneous resolution
Authors: Brawn L A , Bergval U E G , Davies-Jones G A B 
Published: December 2008

Summary
Spontaneous spinal epidural haematoma is of unknown aetiology, but it has been associated with hypertension. Treatment is surgical decompression but three cases of spontaneous recovery have been reported. We report the fourth such recovery in a 68 year old hypertensive woman.
Glucose intolerance during diuretic therapy in elderly hypertensive patients. A second report from the European Working Party on high blood pressure in the elderly (EWPHE)
Authors: Amery A , Birkenhäger W , Brixko P , Bulpitt C , Clement D , Deruyttere M , De Schaepdryver A , Fagard R , Forette F , Forte J , Hamdy R , Leonettil G , O'Malley K , Murphy M , Petrie J , Tuomilehto J , Webster J , Williams B 
Published: December 2008

Summary
Five hundred and seven elderly hypertensive patients were followed for 1 year, 371 for 2 years and 270 for 3 years in a double-blind, randomized, controlled trial in which they received either placebo or 25–50 mg hydrochlorothiazide and 50–100 mg of triamterene daily. One third of the active treatment group also received 250 mg to 2 g methyldopa daily. After 1 year the active treatment group had an average increase in fasting blood sugar of 2.5 mg/dl compared with an average fall of 1.4 mg/dl in the placebo group (P = 0.01). The increase in blood sugar 1 hour and 2 hours after 50 g oral glucose tended to be greater in the actively treated group but these increases did not achieve statistical significance. The effects of diuretic treatment were established after one year and did not increase further over the next 2 years. Overall there was an increase in fasting blood sugar of 5 mg/dl in the active treatment group which occurred mainly in the first year.
The hyperglycaemic effect of diuretics appeared to be partly or wholly related to potassium loss since, in both groups, impairment of glucose tolerance was most marked in those in whom serum potassium decreased. The measures of blood sugar were also positively related to systolic pressure before and after treatment.
Hepatic artery aneurysm
Authors: Curran F T , Taylor S A 
Published: December 2008

Summary
We describe a 58 year old woman who had an aneurysm involving the common hepatic artery, the right and left hepatic arteries and the cystic artery which had ruptured into the liver. It was successfully treated by proximal ligation. The features and management of hepatic artery aneurysm are discussed.
Spontaneous splenic rupture in polyarteritis nodosa
Authors: Ford G A , Bradley J R , Appleton D S , Thiru S , Calne R Y 
Published: December 2008

Summary
A 28 year old man presented with haematuria and renal failure. Renal arteriography revealed bleeding into the pelvis of a solitary right kidney from a hilar artery. Multiple aneurysms were noted in the splenic artery. The spleen subsequently ruptured spontaneously and was removed at laparotomy together with the right kidney. Histological examination of the spleen and kidney revealed an acute necrotizing vasculitis involving medium-sized and smaller arteries confirming a diagnosis of polyarteritis nodosa. An area of infarction involved a subcapsular area of the spleen. Spontaneous splenic rupture is a rare but important complication of systemic vasculitides.
Prediction of spontaneous coronary reperfusion in myocardial infarctionPresented in part on the 57th Scientific Sessions of The American Heart Association, Miami Beach, November 12–15, 1984
Authors: Verheugt F W A , Visser F C , van der Wall E E , van Eenige M J , Res J C J , Roos J P 
Published: December 2008

Summary
To investigate the possibility of predicting the occurrence of spontaneous coronary reperfusion in acute myocardial infarction we studied 91 patients in a randomized trial on the clinical efficacy of intracoronary streptokinase compared to conventional treatment. Of the 46 patients treated conventionally 40 had catheterization 6 weeks after the infarction. Spontaneous coronary reperfusion was found in 19 patients (48%). The time to peak CK-MB in these patients was considerably longer than in patients with streptokinase-induced coronary reperfusion and similar to the time in patients without spontaneous coronary reperfusion. Spontaneous coronary reperfusion was associated with a relative improvement of radionuclide ejection fraction from day 1 to day 14 after admission. There was no difference in the occurrence of ventricular arrhythmia or recurrent ischaemic events between the patients with and those without spontaneous coronary reperfusion.
Thus, spontaneous coronary reperfusion is not uncommon in traditionally treated myocardial infarction, but its occurrence cannot be predicted by enzymatic or clinical parameters.
Alcohol and blood pressure: a social comparison in Zimbabwe
Authors: Bursztyn P G 
Published: December 2008

Summary
The blood pressures of 252 men and 250 women, living in both urban and rural Zimbabwe, were measured on three separate occasions. Food and alcohol intakes were determined using a 3-day weighed diet survey checked by means of a detailed interview. Anthropometric data were also collected. No relationship was found between mean blood pressures and the alcohol intake for any socioeconomic group. Using only the first of the three blood pressure measurements, a correlation between systolic pressure and alcohol intake was found for white males (r = 0.234, P &lt; 0.05), and just missed statistical significance (r = 0.156, P = 0.065) for black middle class males. No relationship was found between blood pressure and alcohol consumption for black working class males, or for females.
Epidemiological evidence suggests that alcohol consumption is associated with increased blood pressure. However, a convincing physiological mechanism is lacking. It is suggested that psychological factors may be partly responsible for this relationship.
Encephalopathy in renovascular hypertension associated with the use of oral contraceptives
Authors: Bradley J R , Reynolds J , Williams P F , Appleton D S 
Published: December 2008

Summary
Two female patients aged 19 years and 27 years presented with hypertensive encephalopathy and were subsequently found to have renal artery stenosis due to fibromuscular dysplasia. Both patients had had normal blood pressures recorded within the previous 6 months whilst taking the oral contraceptive pill. Their neurological state returned to normal with hypertensive control and in one case the hypertension was cured by dilatation of the renal artery stenosis by balloon angioplasty.
Propranolol pharmacokinetics during the menstrual cycle
Authors: Abdu-Aguye I , Dunlop D , Patel P , Turner P 
Published: December 2008

Summary
The pharmacokinetics of propranolol during menstruation and in the mid menstrual cycle have been studied in nine young women taking a single 80 mg tablet on each occasion. There were wide between-individual differences in the serum concentration at any given time (4-5 fold at peak concentrations) but the serum concentration time curves within individuals showed only mild variations. The differences between the average pharmacokinetic parameter estimates for the group did not differ significantly between the two periods of study.
Non-palpable breast lesions: out-patient needle localization and biopsy
Authors: Smith-Behn J , Ghani A 
Published: December 2008

Summary
One hundred and nine patients undergoing out-patient needle localization and biopsy of non-palpable breast lesions were studied. Six patients with carcinoma were detected, 5 of them qualifying as minimal carcinoma. Thirty five patients with proliferative fibrocystic breast disease in need of careful follow-up were identified. While the number of patients with carcinoma was low, the early stage of their disease justifies continued use of the procedure. Doing the procedure on an out-patient basis has been shown by others to provide a substantial reduction in cost. Our results suggest that the out-patient setting does not affect the morbidity or mortality of the procedure.
Pyogenic infection and rheumatoid arthritis
Authors: Rowe I F , Deans A C , Keat A C S 
Published: December 2008

Summary
Ten episodes of severe pyogenic infection occurring in nine patients with rheumatoid arthritis are reported. There was a wide range of presenting features including pyoarthrosis in 7 episodes. Three cases presented with meningitis, bacterial endocarditis and probable multiple abscesses respectively. Infection was caused by Staphylococcus aureus in 7 episodes and by Staphylococcus epidermidis, Streptococcus pneumoniae and beta-haemolytic Streptococcus in each of one episode. Three infective episodes were fatal. Pyogenic, especially staphylococcal, infection should be considered in patients with rheumatoid arthritis with unexplained illness with or without sudden deterioration in joint symptoms. It is important to recognize and treat infection rapidly.
Normal pressure hydrocephalus presenting as Parkinson’s syndrome
Authors: Miodrag A , Das T K , Shepherd R J 
Published: December 2008

Summary
Although extrapyramidal features in normal pressure hydrocephalus (NPH) are not uncommon, presentations with Parkinson’s syndrome as the predominant feature are rare and may give rise to diagnostic difficulties. Failure of patients with parkinsonism to respond to therapy, should alert one to the possibility of NPH.