bluuebunny/crossref_metadata_2025_split huggingface dataset:
Biliary sequelae of endoscopic sphincterotomy
Authors: Greenfield C , Cleland P , Dick R , Masters S , Summerfield J A , Sherlock S 
Published: December 2008

Summary
Twenty five patients were reviewed a mean of 36 months after successful endoscopic sphincterotomy for the removal of bile duct stones. All the patients had improved symptomatically but 20% had episodes of mild abdominal pain and a similar number had elevated serum gamma glutamyltranspeptidase activities (up to 3 times normal). In 12 patients (50%) biliary gas was demonstrated indicating reflux of duodenal contents. Clinical cholangitis did not occur. Aspiration liver biopsy revealed mild portal tract fibrosis and inflammation in patients with biliary reflux. Biliary reflux was significantly associated with mild upper abdominal pain (P &lt; 0.05). This study has shown that mild abnormalities of biliary function persist after endoscopic sphincterotomy. The long term consequence of these changes is unclear.
Six year remission of ACTH-dependent Cushing's syndrome using bromocriptine
Authors: Atkinson A B , Kennedy A L , Sheridan B 
Published: December 2008

Summary
A patient with ACTH-dependent Cushing's syndrome remained in clinical and biochemical remission six years after pituitary irradiation and while on bromocriptine therapy. When bromocriptine was discontinued urinary free cortisol values became elevated, and were not suppressed by dexamethasone. After reintroduction of the drug, remission was again obtained. It is concluded that bromocriptine is responsible for continuing longterm remission in this case. The possible use of bromocriptine as an adjunctive therapy in ACTH-dependent Cushing's syndrome is discussed.
Delayed encephalopathy following cardiac arrest
Authors: Barnes M P , Newman P K 
Published: December 2008

Summary
A 46 year old woman suffered a post-operative cardiac arrest associated with prolonged depression of oxygenation and respiration. She made a good initial recovery but one year later insidiously developed symptoms of widespread central nervous system damage compatible with a delayed post-hypoxic encephalopathy. This case is unusual in the length of time between the hypoxic insult and the later deterioration and also illustrates other atypical features of a delayed post-hypoxic syndrome.
Relationships between radiological and biochemical evidence of rickets in Asian schoolchildren
Authors: Abdul-Motaal A , Gettinby G , McIntosh W B , Sutherland G R , Dunnigan M G 
Published: December 2008

Summary
One hundred Asian schoolchildren provided evidence of the relationships between radiological and biochemical evidence of rickets in a vitamin D-deficient population. In a retrospective study of the X-rays of 56 children the variables serum alkaline phosphatase, inorganic phosphorus and age provided a discriminant function which correctly classified 10 of 11 children with radiological evidence of rickets and 44 of 45 children with negative or marginally abnormal X-rays. When the discriminant function was applied to a prospective study of 44 children, three children with radiological evidence of rickets were correctly classified together with 38 of the remaining 41 children with negative or marginally abnormal X-rays. Serum alkaline phosphatase was the most important variable in the discriminant analysis, followed by serum inorganic phosphorus and age. Low levels of serum 25-hydroxy vitamin D (25-OHD) are of little value in predicting the severity of radiological evidence of rachitic bone disease in a vitamin D-deficient population.
Requests for hypnotic drugs and placebo response in elderly hospital in-patients
Authors: Bayer A J , Pathy M S J 
Published: December 2008

Summary
Requests for night sedation and the use of placebo as first line drug management were studied prospectively in 1174 consecutive elderly hospital in-patients. Of the 390 (33.2%) patients requesting sleeping pills in hospital, 37 were subsequently satisfied without the prescription of additional medication. A further 216 patients were entirely satisfied with a placebo capsule during all of their hospital stay. An ‘active’ hypnotic drug was required by only 137 patients, many of whom were noisy and disturbing other patients in the ward. Most of the active hypnotic drugs prescribed to elderly hospital patients are unnecessary and a majority of those requesting hypnotics consistently respond to placebo. There remains a need for greater education of patients, nurses and doctors in the non-pharmacological management of sleep disorders.
Atrial myxoma presenting with cerebral haemorrhage
Authors: Macaulay V M , Crawford P J , McKeran R O 
Published: December 2008

Summary
Emboli from left atrial myxomas are a recognized cause of cerebral ischaemia. The myxomatous embolus may infiltrate the cerebral arterial wall, resulting in aneurysmal dilatation with a risk of rupture. Myxoma-associated cerebral haemorrhage has been described in patients with progressive neurological dysfunction. We report a new presentation. Our patient, a previously healthy 20 year old girl, developed acute intracerebral haemorrhage for which craniotomy was performed. Histology of evacuated haematoma revealed an intravascular fragment of myxoma. Echocardiography demonstrated a left atrial myxoma which later was uneventfully excised. Early diagnosis of embolic cardiac myxoma requires awareness of the diversity of clinical manifestations, and careful histological analysis of surgical specimens.
Severe oesophageal injury caused by Steradent
Authors: Barclay G R , Finlayson N D C 
Published: December 2008

Summary
An elderly woman swallowed 2 tablets of a denture-cleansing agent (Steradent) believing them to be her sleeping tablets. This caused severe burning pain in the throat and resulted in a tight postcricoid oesophageal stricture. Treatment by repeated dilatation of the stricture has been only partially successful. Characteristic containers for non-medicinal tablets might help those with poor vision, and medicinal and non-medicinal tablets should never be stored in the same place.
Oncogenic osteomalacia: strange tumours in strange places
Authors: Weiss D , Bar R S , Weidner N , Wener M , Lee F 
Published: December 2008

Summary
Two patients presented with hypophosphataemic osteomalacia and were subsequently found to have small tumours unusual histopathology and location causing the osteomalacia. Each tumour was found after an intensive search for occult masses. Studies of vitamin D metabolism and renal tubular function before and after surgery yielded further insight into the pathophysiology of oncogenic osteomalacia. These cases demonstrate that microscopic quantities of tumour are capable of causing the syndrome and further illustrate the high index of suspicion often necessary to locate causative tumours in patients with hypophosphataemic osteomalacia.
Echo-free renal masses on ultrasound: the stethoscope as an adjunct to their diagnosis
Authors: Suarez R , Lynn A H 
Published: December 2008

SummaryA patient with an intrarenal arteriovenous malformation is described. Ultrasound suggested this to be a renal cyst but auscultation revealed a loud bruit and, on the basis of this, arteriography rather than cyst puncture was carried out.
Increased plasma triglycerides, cholesterol and apolipoprotein E during prolonged fasting in normal subjects
Authors: Markel A , Brook J G , Aviram M 
Published: December 2008

Summary
Plasma lipid and high density lipoprotein (HDL) levels were studied in 20 normal, healthy, non-obese males while fasting (150 kcal/d with free intake of water) for 6 d in a hunger strike. Plasma triglyceride and cholesterol levels were increased by 18% after 6 d of fasting. HDL-cholesterol concentration was not significantly changed for 4 d, but decreased by 22% after 6 d. Platelet aggregation induced by adenosine diphosphate (ADP) or collagen after 6 d of fasting was in the normal range. In 3 subjects fasted for 9 d, a complete plasma lipoprotein analysis was done. Very low and low density lipoprotein (VLDL and LDL) levels were elevated, whereas HDL was reduced after 9 d of fasting. On isoelectric focusing analysis, a marked reduction in apolipoprotein (apo) E concentration in both VLDL and HDL was noted. Liver function tests showed a reduction in hepatic enzyme activity; and since apo E is of hepatic origin also, we suggest that long fasting inhibits liver function in normal subjects.
Chronic dyspepsia pain in general practice—its causes and diagnosis
Authors: Lance P , Gibson-Glubb S , Gazzard J A , Gazzard B G 
Published: December 2008

Summary
One hundred consecutive patients who had consulted their general practitioner because of upper abdominal pain related to eating, were investigated after initial interviews by the general practitioner, a medical registrar and the same consultant physician. Thirty seven had active upper gastrointestinal or biliary tract diseases, including 29 with peptic ulcers. The general practitioner and consultant correctly distinguished between organic and non-organic dyspepsia (NOD) in 51 and 65 cases respectively. Although the sensitivity of the general practitioner diagnosis of organic disease was high (95%), the specificity (23%) and predictive value (42%) were low.
There were fewer organic diagnoses amongst the patients under the age of 30 (P &lt; 0.05) and those with symptoms for less than 3 months (P &lt; 0.01). No patient under 30 with symptoms for less than 3 months had organic dyspepsia. We suggest that if dyspeptic patients over the age of 30 and those under 30 with symptoms for longer than 3 months are investigated, about one-third will be found to have organic diseases.
Placental chorioangiomatosis—a high risk pregnancy
Authors: Jaffe R , Siegal A , Rat L , Bernheim J , Gruber A , Fejgin M 
Published: December 2008

SummaryA case of diffuse chorioangiomatosis leading to fetal hydrops, disseminated intravascular coagulopathy with massive umbilical vein thrombosis and fetal death is described. Although rare, this benign mesenchymatous malformation of the placenta should be kept in mind as a possible cause of neonatal morbidity. Prenatal diagnosis could prevent fetal death.
Reversible renal failure due to psychogenic urinary retention
Authors: Korzets Z , Garb R , Lewis S , Bernheim J L 
Published: December 2008

Summary
A case of advanced, reversible renal failure due to psychogenic urinary retention occurring in a 17 year old female, is reported. The diagnosis of psychogenic urinary retention was made on the basis of existent florid psychopathology and the concomitant exclusion of an organic cause. Family psychodynamics are discussed. Psychosocial intervention led to a resumption of normal micturition, the disappearance of the urinary retention with resultant improvement of renal function.
Improved cardiac function after renal transplantation
Authors: Fleming S J , Caplin J L , Banim S O , Baker L R I 
Published: December 2008

Summary
There are few reports of the outcome of renal transplantation in patients with severe left ventricular (LV) impairment. We describe three men with chronic disabling heart failure associated with LV dysfunction in whom a remarkable improvement in cardiac function followed renal transplantation. Transplantation may offer the prospect of successful rehabilitation in these circumstances. Undue pessimism as to the prognosis in such patients is unwarranted.
Massive ascites due to omental endometriosis
Authors: Naraynsingh V , Raju G C , Ratan P , Wong J 
Published: December 2008

Summary
Endometriosis associated with massive ascites is an unusual combination. Only 12 cases have been reported since its first description by Brews in 1954. The authors report the first case where radical surgery was avoided because of successful hormonal therapy.
Nonspecific small bowel ulceration
Authors: Thomas W E G , Williamson R C N 
Published: December 2008

Summary
Six patients (4 male, 2 female) developed nonspecific small bowel ulceration between the ages of 4 months and 76 y. Five had gastrointestinal haemorrhage, usually chronic and resulting in iron deficiency anaemia. Four had features of subacute intestinal obstruction; there were no perforations. A small bowel enema was the most useful single investigation for delineating the lesions, and surgical excision was curative in all but one case. No aetiological causes could be implicated, other than in one patient taking a daily tablet of Navidrex-K.
Post partum presentation of hypercalcaemic sarcoidosis
Authors: Wilson-Holt N 
Published: December 2008

Summary
A number of corticosteroid responsive diseases have been shown to undergo exacerbation in the puerperium. The presentation of a woman 8 weeks after delivery with severe hypercalcaemia, a highly steroid sensitive feature of sarcoidosis, adds to the evidence that sarcoidosis can also be numbered amongst such diseases with relapse in the puerperium.
Acute pancreatitis in association with small cell lung carcinoma: potential pitfall in diagnosis and management
Authors: Allan S G , Bundred N , Eremin O , Leonard R C F 
Published: December 2008

Summary
Tumour metastases to the pancreas are a rare but recognized cause of acute pancreatitis, there is a 24–40% incidence of pancreatic involvement from small cell lung cancer in autopsy series but only a very few cases of tumour-induced acute pancreatitis have been described. Chemotherapy has been advocated as the primary therapy in patients with known oat cell carcinoma who develop acute pancreatitis. We describe 2 patients with acute haemorrhagic pancreatitis in association with disseminated small cell carcinoma but without evidence of tumour invasion in the gland and with gall stones present in the gall bladder. Chemotherapy would have been inappropriate therapy for these patients.
Pyoderma gangrenosum in myelodysplasia and acute leukaemia
Authors: Jacobs P , Palmer S , Gordon-Smith E C 
Published: December 2008

Summary
Pyoderma gangrenosum is a rare occurrence in patients with haematological malignancy. This characteristic but nonspecific inflammatory process with skin destruction occurred in 4 patients with myelodysplasia, in one with acute leukaemic transformation of myelofibrosis, and in de novo acute myeloblastic leukaemia in another. Clinically, the cutaneous lesion in these patients differed from that associated with inflammatory bowel disease, arthritis, or the idiopathic type of pyoderma gangrenosum by having the vesiculo-bullous borders. Histopathological differences were also evident since more superficial layers of the skin were involved in the ulceration than typically encountered in patients with non-malignant systemic disease.
Despite the less penetrating nature of this variant, treatment of the pyoderma gangrenosum is unsatisfactory and in the absence of effective therapy for the underlying disease, healing occurred only in the patient with acute leukaemia who achieved complete remission in response to chemotherapy.
Reversibility of acute renal failure in elderly patients with the nephrotic syndrome
Authors: Searle M , Cooper C , Elliman J , Dathan R , Maciver A 
Published: December 2008

Summary
Acute renal failure may occur in the nephrotic syndrome due to minor glomerular changes, especially in the elderly. We describe five cases and review the literature. Previous renal damage due to ischaemia and drugs may be important in pathogenesis. We stress the importance of active management of these cases, as the renal lesions are reversible and recovery can be expected.
Myocarditis and fulminant hepatic failure from coxsackievirus B infection
Authors: Read R B , Ede R J , Morgan-Capner P , Moscoso G , Portmann B , Williams R 
Published: December 2008

Summary
A case of fulminant hepatic failure in association with myocarditis is reported. Presentation suggested an acute hepatitis which was complicated by cardiac failure. Evidence of severe myocarditis was found at autopsy.
A comparison of diltiazem and atenolol in angina
Authors: Wheatley D 
Published: December 2008

Summary
Diltiazem was compared to atenolol in a double-blind trial involving 78 patients suffering from coronary heart disease. Following a 2 week control period, patients were randomly allocated to 6 weeks treatment with one or the other drug.
The patients themselves made daily records of anginal attacks, trinitrate requirements, well-being and exercise tolerance. With both drugs there were highly significant reductions in the anginal attack rate and trinitrate requirements, and significant improvement on the other measures. However, there were no significant between drug differences.
The incidence of side effects with diltiazem was very low and no patient had to omit treatment for this reason, although three patients did so on atenolol.
A case of ocular toxicity to ethambutol—an idiosyncratic reaction?
Authors: Karnik A M , Al-Shamali M A , Fenech F F 
Published: December 2008

Summary
Optic neuritis, a well known adverse effect of ethambutol, is related to the dose and duration of the therapy. The patient described here developed rapidly progressive deterioration of vision after only 3 days of treatment with ethambutol. Such a case has not been reported before and it is suspected that this was an idiosyncratic reaction.
Breast disease in young West Indian women: an analysis of 1051 consecutive cases
Authors: Raju G C , Jankey N , Naraynsingh V 
Published: December 2008

Summary
Our analysis of 1051 breast biopsies in West Indian women under the age of 30 y revealed that 99% of the breast lumps were benign. Fibroadenoma was the commonest (67%) lesion and there was a steady increase in the frequency of fibrocystic disease with age. Carcinoma in this group is therefore rare. Thus most patients can be reassured with certainty of their benign disease and have biopsy at a convenient time.
The value of 5-aminosalicylic acid in inflammatory bowel disease for patients intolerant or allergic to sulphasalazine
Authors: Donald I P , Wilkinson S P 
Published: December 2008

Summary
The use of sulphasalazine in inflammatory bowel disease is often limited by intolerance or allergy. In previous studies 5-aminosalicylic acid (5ASA), the active ingredient of sulphasalazine, coated with an acrylic resin, has been shown to be as effective as sulphasalazine in maintaining remission. In this study coated 5ASA was given to 37 patients intolerant or allergic to sulphasalazine. Thirty-three patients have tolerated 5ASA satisfactorily, and most experienced improved control of their disease. Four patients reported similar side effects with sulphasalazine and 5ASA.
Audit of nebuliser use
Authors: Williams P E , Renowden S A , Ward M J 
Published: December 2008

Summary
The use of nebulisers was assessed in four hospitals. Nebulisers were checked in use and medical and nursing staff were interviewed. All but one nebuliser was driven by 100% oxygen and only 3 of 111 interviewees preferred air for patients with hypercapnia. In 5 of 44 nebulisers in use, water was used as the dilutant. The calculated times for complete nebulisation of the solutions ranged from 3.5 to 117 min. The results of this survey illustrate a need for better education concerning the use of nebulisers in hospitals.
Coxsackie viral myocarditis
Authors: O'Connell John B , Robinson John A 
Published: December 2008

SummaryCoxsackie viral myocarditis is a common disease, yet idiopathic dilated cardiomyopathy is a less common consequence. Insights gained from studying the Coxsackie virus B-3 murine model of myocarditis has led to the hypothesis that an acute Coxsackie viral myocarditis can result in persistent, non-viral mediated cellular responses that result in a chronic inflammatory state leading to progressive myocyte loss and ultimate development of dilated cardiomyopathy. Although the evidence linking myocarditis to dilated cardiomyopathy is circumstantial in man, the identification of defects in immunoregulation may provide the impetus to further research into the pathogenesis and ultimately the development of more rational therapies directed at modulating immune responses to alter the natural history of clinical dilated cardiomyopathy.
Thyrotrophin augmentation after commencing thyroxine replacement in primary hypothyroidism
Authors: Ghose R R , Upadhyay H P 
Published: December 2008

Summary
Prospective measurements of serum thyrotrophin and thyroxine concentrations were made in six patients with primary hypothyroidism treated consecutively with an incremental regimen of oral thyroxine. A fall in thyrotrophin occurred over several months, accompanied by a concurrent slow rise in serum thyroxine. Those patients with the highest initial values for thyrotrophin showed the typical curvilinear decline in thyrotrophin, whereas the remaining patients disclosed a transient rise in thyrotrophin for the first 3 months. This paradoxical rise was not associated with depression of cardiac output or glomerular filtration rate.
The significance of thyrotrophin augmentation is uncertain, but it may be more common than generally appreciated. It did not occur in those patients with the most severe degrees of thyroid deficiency. Thyroxine exerts a dual action, and augmentation of thyrotrophin may reflect a dominant effect of increased protein synthesis, in contrast to negative feedback inhibition which suppresses thyrotrophin. These opposing actions are in competition at different dose levels of thyroxine, and may contribute not only to augmentation or suppression of thyrotrophin, but also to the curvi-linear pattern of fall. Such variations impair the utility of thyrotrophin as an index of euthyroidism.
Twice daily tripotassium dicitrato bismuthate in the treatment of duodenal ulceration
Authors: Hollanders D 
Published: December 2008

Summary
Fifty three patients with endoscopically proven duodenal ulceration have cooperated in a clinical trial to compare the ulcer healing effect of tripotassium dicitrato bismuthate (TDB) at standard dosage administered either twice or four times daily. No statistically significant difference has been found to exist between ulcer healing in the two groups at 4 weeks (72% and 67%, P = 0.944) or at 8 weeks (92% and 81%, P = 0.504) and it is concluded that twice daily TDB maintains the effectiveness of the drug and has advantages for patient compliance.
Colorectal lymphoma simulating inflammatory colitis and diagnosed by immunohistochemistry
Authors: Sagar S , Selby P , Sloane J , McElwain T J 
Published: December 2008

Summary
Lymphomatous colitis is probably an uncommon syndrome but its recognition may be of importance to patients under the care of gastroenterologists or oncologists. The case of an elderly man with lymphocytic lymphoma who developed lymphomatous colitis 6 years after initial presentation is reported.
T-cell lymphoblastic lymphoma of the uterus complicated by Chlamydia trachomatis pneumonia
Authors: Cunningham D , Gilchrist N L , Lee F D , Haxton M , Heppleston A , Forrest G J , Soukop M 
Published: December 2008

Summary
This is the first documented case of a T-cell lymphoblastic lymphoma arising in the uterus. At presentation, the patient also had a life-threatening pneumonia due to Chlamydia trachomatis which responded to erythromycin and tetracycline. Cytotoxic therapy produced partial tumour regression, but the patient died 14 weeks after diagnosis, probably as a result of intercurrent infection.