bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anti-mitochondrial antibodies in patients with Graves' disease may not signify primary biliary cirrhosis
Authors: Perros P , Palmer J M , Yeaman S J , Kendall-Taylor P 
Published: December 2008

Summary
Two patients with Graves' disease were incidentally found to have anti-mitochondrial antibodies by immunofluorescence in the absence of symptoms, clinical signs or biochemical evidence of liver dysfunction. Anti-mitochondrial antibody titres became undetectable in both patients on follow-up. Screening of the patients' sera by immunoblotting against the purified antigens of the M2 complex was negative. We conclude that in these cases, anti-mitochondrial antibodies detected by immunofluorescence were directed against antigens other than the primary biliary cirrhosis-associated M2 complex and therefore did not signify subclinical primary biliary cirrhosis.
Perforated typhoid enteritis in children
Authors: Gupta Vineeta , Gupta Sanjeev K , Shukla Vijay K , Gupta Saroj 
Published: December 2008

Summary
A prospective study of 65 patients with perforated typhoid enteritis managed operatively over a 3 year period at a university hospital is presented. There were 45 males and 20 females with ages ranging from 5 to 15 years. Presenting symptoms were fever, abdominal pain, vomiting and either diarrhoea or constipation. All the patients were subjected to surgery and 56 (86%) underwent two-layer bowel closure after freshening of ulcer margins. The overall mortality rate in this study was 20% and was adversely influenced by the increasing duration of perforation, presence of shock and faecal peritonitis.
Early surgery after prompt and adequate resuscitation is life saving. However, prevention of typhoid fever by providing safe drinking water and better sanitary conditions appears to offer the best chance of decreasing the high rates of mortality and morbidity of this deadly disease.
Warfarin treatment and migraine
Authors: Suresh C G , Neal D , Coupe M O 
Published: December 2008

Summary
A patient suffering from migraine, whose symptoms were abolished by warfarin therapy, is reported. Warfarin was prescribed for deep vein thrombosis and the frequency of the patient's headache improved remarkably during the anticoagulant therapy. Because of the unusual nature of the response to anticoagulant therapy, warfarin was reintroduced on a double blind (versus placebo) basis and once again abolished the headaches.
Pulmonary hypertension associated with non-cirrhotic portal hypertension in systemic lupus erythematosus
Authors: Woolf Desmond , Voigt Michael D , Jaskiewicz Kasimir , Kalla Azga A 
Published: December 2008

Summary
A case of non-cirrhotic portal hypertension in a patient with systemic lupus erythematosus, the first of our knowledge, is described. Severe pulmonary hypertension was associated with the portal hypertension and with markers of active auto-immunity. Pulmonary hypertension has not previously been associated with non-cirrhotic portal hypertension. The coexistence of vasculopathy of the portal and pulmonary vascular beds in this patient with active autoimmunity supports the postulate that portal-pulmonary hypertension may be immunologically mediated.
Tracheoesophageal fistula as the presenting manifestation of Hodgkin's lymphoma
Authors: Alba David , Lobato Salvador Díaz , Alvarez-Sala Rodolfo , Villasante Carlos , Echevarría Celina 
Published: December 2008

Summary
We present a patient with tracheoesophageal fistula as the initial manifestation of Hodgkin's disease with oesophageal involvement. To our knowledge, this has not been previously reported. The diagnosis of Hodgkin's lymphoma was made at autopsy.
The effect of different nitrate preparations on plasma heparin concentrations and the activated partial thromboplastin time
Authors: Brack Michael J , More Ranjit S , Hubner Peter J B , Gershlick Anthony H 
Published: December 2008

Summary
There is evidence that intravenous nitrates which are frequently used in acute coronary syndromes may interfere with the anticoagulant effect of heparin. We compared the effect of two different nitrate preparations on the activated partial thromboplastin time (APTT), anti-thrombin III activity (AT III) and plasma heparin levels in patients (n = 50) undergoing routine percutaneous transluminal coronary angioplasty (PTCA) for stable angina. Patients were randomized to either: (1) intravenous heparin and nitroglycerin (GTN); or (2) intravenous heparin and isosorbide dinitrate. The APTT, plasma heparin concentration and AT III activity were measured before PTCA and at 2 and 4 hours after commencement of infusions. Both groups received identical doses of heparin. Group 1 patients received a constant dose of 16.6 micrograms/minute of GTN, and group 2 patients received 33.3 micrograms/minute of isosorbide dinitrate.
At 4 hours the median APTT ratio was significantly lower in group 1 compared with group 2 (2.6 versus 4.5) (P &lt; 0.05) as was the plasma heparin concentration (0.18 U/ml versus 0.32 U/ml (P &lt; 0.05). However, no significant difference in APTT ratios or plasma heparin concentrations were noted at any of the other sample times. AT III activity was not significantly different between the groups at any sample time. Within-group analysis showed significantly lower APTT ratio and heparin concentrations at 4 hours compared with the respective 2 hour values.
These results would suggest that there is a potential impairment of anticoagulation with low-dose intravenous nitroglycerin and to a lesser extent with low-dose isosorbide dinitrate. Early and frequent monitoring may therefore be appropriate when intravenous nitrates and heparin are used in combination.
Aortocaval fistula: a rare cause of paradoxical pulmonary embolism
Authors: Bridger J E 
Published: December 2008

Summary
An 83 year old woman died suddenly from a paradoxical pulmonary embolus which had originated in an abdominal aortic aneurysm and embolised via an aortocaval fistula. This lesion should be considered in the differential diagnosis of embolic disease.
A case of narcotic bowel syndrome successfully treated with clonidine
Authors: Wong Voishim , Sobala George , Losowsky Monty 
Published: December 2008

Summary
Patients with chronic abdominal pain without an organic basis present a difficult management problem. Some of these patients may be prescribed opiates initially which may result in requiring progressively higher doses for pain relief. In this clinical setting, the suspicion of narcotic bowel syndrome should be borne in mind. With appropriate treatment and counselling, further invasive investigations including laparotomy may be avoided and resolution of symptoms can be achieved with clonidine. This case report demonstrates such a typical clinical scenario and discusses the possible aetiology and pathophysiology of narcotic bowel syndrome as well as the role of clonidine in controlling opiate withdrawal symptoms.
Acute renal failure in patients with type 1 diabetes mellitus
Authors: Woodrow G , Brownjohn A M , Turney J H 
Published: December 2008

Summary
Acute renal failure (ARF) is a serious condition which still carries a mortality of around 50%. People with diabetes may be at increased risk of developing ARF, either as a complication of diabetic ketoacidosis or hyperosmolar coma, increased incidence of cardiovascular disease, or due to increased susceptibility of the kidney to adverse effects in the presence of underlying diabetic renal disease. During the period 1956-1992, 1,661 cases of ARF have been treated at Leeds General Infirmary. Of these, we have identified 26 patients also having type 1 diabetes. ARF due to diabetic ketoacidosis is surprisingly uncommon (14 cases out of 23 patients whose notes were reviewed). All cases of ARF complicating ketoacidosis in the last decade have been associated with particularly severe illness requiring intensive care unit support, rather than otherwise 'uncomplicated' ketoacidosis.
We discuss the conditions that may result in ARF in patients with diabetes and the particular difficulties that may be encountered in management.
Multiple strokes after initiation of steroid therapy in giant cell arteritis
Authors: Collazos Julio , García-Moncó Carlos , Martín Aitor , Rodriguez Jose , Gómez Ma Angeles 
Published: December 2008

Summary
We report the case of a 66 year old woman with clinical manifestations of giant-cell arteritis, positive temporal artery biopsy and excellent response to prednisone, who developed massive cerebral infarcts after 5 days of treatment. Computed tomographic and magnetic resonance imaging scans revealed multiple infarcts in areas irrigated by both the carotid and vertebrobasilar systems bilaterally. A four-vessel angiography performed 19 days later revealed only mild atheromatous disease. Anticardiolipin antibodies were negative and a transoesophageal echocardiogram was normal.
Stroke during the first 2 weeks of therapy in giant-cell arteritis, especially in the vertebrobasilar territory, has been previously reported. Anticoagulation during the first weeks of steroid treatment in these patients might be advisable.
Prolonged remission of hypercalcaemia due to parathyroid carcinoma with pamidronate
Authors: Newrick P G , Braatvedt G D , Webb A J , Sheffield E , Corrall R J M 
Published: December 2008

Summary
Parathyroid carcinoma is rare and the associated hypercalcaemia is often resistant to all treatment. A case is described in which prolonged control of hypercalcaemia has been achieved by infrequent infusions of pamidronate despite continuing hypersecretion of parathyroid hormone.
Role of respiratory sleep disorders in the pathogenesis of nocturnal angina and arrhythmias
Authors: Liston R , Deegan P C , McCreery C , McNicholas W T 
Published: December 2008

Summary
This report documents how respiratory sleep disorders can adversely effect ischaemic heart disease. Three male patients (aged 60-67 years) with proven ischaemic heart disease are described. They illustrate a spectrum of nocturnal cardiac dysfunction, two with nocturnal angina and one with nocturnal arrhythmias. Full sleep studies were performed in a dedicated sleep laboratory on all patients, and one patient had 48 hours of continuous Holter monitoring. Two patients were found to have obstructive sleep apnoea with apnoea/hypopnoea indices of 57 and 36 per hour, respectively, the former with nocturnal arrhythmias and the latter with nocturnal angina. In both cases, nasal continuous positive airways pressure successfully treated the sleep apnoea, with an associated improvement in nocturnal arrhythmias and angina. The third patient who presented with nocturnal angina, did not demonstrate obstructive sleep apnoea (apnoea/hypopnoea index = 7.2) but had significant oxygen desaturation during rapid eye movement (REM) sleep. This patient responded to a combination of nocturnal oxygen and protriptyline, an agent known to suppress REM sleep, and had no further nocturnal angina. All patients were considered to be an optimum cardiac medication and successful symptom resolution only occurred with the addition of specific therapy aimed at their sleep-related respiratory problem. We conclude that all patients with nocturnal angina or arrhythmias should have respiratory sleep abnormalities considered in their assessment.
Giant cell arteritis presenting as oculomotor nerve palsy with pupillary dilatation
Authors: Davies G E , Shakir R A 
Published: December 2008

Summary
Acute complete oculomotor palsy with headache is a classical presentation of an extrinsic compression most commonly due to a posterior communicating artery aneurysm. We present a patient with such a presentation but with histologically proven giant cell arteritis. This possibility should be considered especially in the elderly to avoid complications and the need for angiography.
Gastric telangiectasis: a rare cause of severe blood loss in CREST syndrome
Authors: el-Omar M M , Jenkins A P , Hollowood K , Banerjee A K , Thompson R P H 
Published: December 2008

Summary
A 46 year old woman presented with the CREST variety of systemic sclerosis and occult gastrointestinal bleeding due to vascular malformations of her stomach. Partial gastrectomy cured her anaemia. In systemic sclerosis, visceral angiography should be performed early when initial investigations have been negative.
Omeprazole in the treatment of asthmatics with nocturnal symptoms and gastro-oesophageal reflux: a placebo-controlled cross-over study
Authors: Ford G A , Oliver P S , Prior J S , Butland R J A , Wilkinson S P 
Published: December 2008

Summary
Eleven adult patients with nocturnal asthma, and gastro-oesophageal reflux documented by endoscopy or ambulatory oesophageal pH monitoring completed a double-blind cross-over study (4 week treatment, one week run-in and cross-over periods) comparing the effects of omeprazole 20 mg daily and placebo on asthma control assessed by symptoms, peak expiratory flow rate and bronchodilator usage. Omeprazole treatment did not improve asthma symptoms during the day or night, or peak expiratory flow rate readings. There was no difference in bronchodilator inhaler usage during omeprazole therapy.
Treatment of gastro-oesophageal reflux with omeprazole in patients with nocturnal asthma and gastro-oesophageal reflux does not improve asthma symptoms or peak expiratory flow rate. This suggests that gastro-oesophageal reflux does not exacerbate bronchoconstriction in nocturnal asthma.
Views of hospital staff on the management of hypertension
Authors: Hutchinson P J A , Trill A S , Turner P , Jackson S H D 
Published: December 2008

Summary
A questionnaire concerning the detection and management of hypertension was presented to 265 hospital doctors, 114 medical students and 59 student nurses. Of these 75% were completed. Although only 76% thought that routine measurement was necessary in outpatients, 92% of respondents thought that blood pressure (BP) should be measured routinely in all in-patients. A total of 17% of all doctors and 11% of physicians indicated that they would not use drug treatment until the diastolic BP exceeded 105 mmHg. Thirty-four per cent of respondents still use diastolic phase IV and 84% felt that BP should be measured 2-4 times before deciding on treatment but the posture of the patient (lying, sitting or standing) during recording was inconsistent. Seventy-seven per cent of respondents indicated that they recorded BP to the nearest 5 mmHg and 4% to the nearest 10 mmHg. Despite the literature on the subject, there are still widely differing opinions amongst medical staff on how to record BP and at what level it should be treated.
Cardiac tamponade after thrombolysis
Authors: Heymann T D , Culling W 
Published: December 2008

Summary
Thrombolysis has been very effective in reducing the morbidity and mortality from acute myocardial infarction. Serious adverse events are not uncommon, however. We describe a case in which a haemopericardium and tamponade developed in a patient with a history of recurrent idiopathic pericarditis and to whom streptokinase had been administered following a suspected myocardial infarction. The case highlights the need for caution in the administration of thrombolytics to patients with a documented history of pericarditis.
Invasive pulmonary aspergillosis: a rare presentation of non-Hodgkin's lymphoma
Authors: Garcia-Gonzalez Miguel , Sanroman Antonio L , Arribas Rosario , Torres Gustavo , Cuesta Carmen , Moreira Victor F 
Published: December 2008

Summary
We describe a patient with rapidly progressive pneumonia and a high level of serum lactate dehydrogenase, in whom postmortem study revealed the presence of a diffuse, small and large-cell multicentric non-Hodgkin's lymphoma, together with an invasive pulmonary aspergillosis. Aspergillosis is rare as a presenting feature of a lymphoproliferative disease; only one previous case has been reported to the best of our knowledge. Invasive aspergillosis and lymphoma should be considered in patients presenting with pneumonia and high level of lactate dehydrogenase.
Malignant astrocytoma of the cervico-medullary junction masquerading as Guillain-Barré syndrome
Authors: Beards S C , Robertson L J , Jackson A , Lipman J 
Published: December 2008

Summary
Brainstem gliomas are rare primary brain tumours which most commonly occur in the midbrain and pons. Malignant gliomas and tumours at the cervico-medullary junction are particularly unusual. The diagnosis of tumours at this site is particularly difficult using computed tomographic (CT) scanning owing to artifacts around the base of the skull. Intrinsic tumours of the cervico-medullary junction may lead to a dissociated motor deficit and the onset of symptoms can be rapid. We describe a patient in whom an isolated ascending motor deficit in association with a raised cerebrospinal fluid protein and a normal CT scan led to an erroneous diagnosis of Guillain-Barré syndrome. The patient was treated on the intensive care unit for an 8-week period before further investigation demonstrated a malignant glioma of the cervico-medullary junction. We recommend confirmation of the diagnosis of polyradiculopathy by nerve conduction studies wherever possible.
Dexamethasone-suppressible feminizing adrenal adenoma
Authors: Paja M , Díez S , Lucas T , Ojeda A , Salto L , Estrada J 
Published: December 2008

Summary
A 39 year old man presented with gynaecomastia, loss of libido and high blood pressure. Hormone studies revealed elevated plasma levels of oestradiol and its precursors, which increased in response to adrenocorticotrophic hormone and were reduced to normal levels with dexamethasone. Computed tomography disclosed a left adrenal mass and surgery was performed. The removed tumour weighed 84 g and the histological diagnosis was of adenoma. Nine years after surgery, he is asymptomatic, without hypertension, and radiological and or hormonal evidence of recurrence. We discuss the hormone profile in this case and the dynamics of steroid production by the tumour which, in contrast to the classical concept of tumour autonomy, showed dependence of oestradiol secretion on endogenous adrenocorticotrophic hormone.
Twenty-four hour ambulatory blood pressure and heart rate in a patient with a predominantly adrenaline secreting phaeochromocytoma
Authors: Gallen I W , Taylor R S , Salzmann M B , Tooke J E 
Published: December 2008

Summary
In this report, we present the symptoms, biochemical investigations, 24 hour ambulatory blood pressure and heart rate recordings in a patient before and following removal of a predominantly adrenaline-secreting phaeochromocytoma. The symptoms were of episodic shaking, faintness, nausea, palpitations, sweating and panic, chest and neck pain with headache, and are consistent with previous reports. Ambulatory blood pressure recording demonstrated that mean daily blood pressure was normal, with normal diurnal variation, and two episodes of severe hypertension and bradycardia coincident with symptoms (MAP 150 mmHg and HR 49 beats/minute, MAP 178 mmHg and HR 29 beats/minute, respectively), not reported in predominantly adrenaline-secreting phaeochromocytoma.
Angiographic comparison of coronary artery disease between Asians and Caucasians
Authors: Dhawan J , Bray C L 
Published: December 2008

Summary
Asians in the United Kingdom surpass the already high mortality from coronary artery disease seen in Caucasians. In the present study, the angiographic features of consecutive series of 87 Caucasians, 83 British Asian and 30 Asian patients in India with coronary artery disease were assessed. Blood samples at fasting and after ingestion of 75 g of dextrose were taken to assess the extent of diabetes. Fasting blood samples were also taken for measurement of cholesterol, high-density lipoprotein cholesterol and triglyceride. Coronary angiograms were scored by two independent observers who were blinded to the patients' ethnic origin.
The Asians were younger than the Caucasians, but did not differ in their body mass index, systolic or diastolic blood pressure or in cigarette consumption. Lipids were similar apart from Indian Asians having lower cholesterol than British Asians, and Caucasians having lower triglyceride than Asians. There were more diabetics in Asians than in Caucasians. Asians in Britain wait longer than Caucasians and Asians in India from onset of angina to undergoing coronary angiography.
The presence of triple vessel disease was not significantly different (P = 0.19) in the three groups, that is, 38%, 43% and 27% in Caucasians, British Asians and Indian Asians, respectively. The geometric mean coronary score was 26.3 (C.I. 22.6-30.6), 25.3 (C.I. 21.8-29.4), and 25.2 (C.I. 19.6-32.5) in Caucasians, British Asians and Indian Asians, respectively. This difference was not significant (P = 0.92).
Total number of lesions more than three were similar, that is, in 25% Caucasian, 41% British Asian and 40% Indian Asian patients (P &lt; 0.10). British Asians had less proximal disease (P = 0.0002), and Indian Asians less distal disease (P = 0.003) compared to Caucasians. Non-discrete (long) lesions were more prevalent in Asians than Caucasians (P = 0.0005) The total number of lesions more than three in diabetic Asians was significantly more than in the non-diabetic, 71% versus 31% in British Asians (P = 0.002) and 90% versus 15% in Indian Asians (P= 0.0001). The relationship between diabetes and long lesions in both British and Indian Asians was highly significant (P &lt; 0.00001 and P &lt; 0.001, respectively).
Thus severity and extent of coronary disease is no different in Asians as compared to Caucasians. Diabetes is perhaps responsible for the more diffuse disease seen in Asians.
Leiomyosarcoma in leiomyomatosis of the small intestine
Authors: El-Omar Magdi , Davies Jason , Gupta Sandeep , Ross Harvey , Thompson Richard 
Published: December 2008

Summary
Multiple leiomyomata of the small intestine are rare. We report one such case where a leiomyosarcoma had arisen from a leiomyoma in the small intestine 8 years after presentation. The possible origin of the leiomyomata is discussed and it is concluded that small intestinal leiomyomatosis should be regarded as a premalignant condition.
Salt, hypertension and renal disease: comparative medicine, models and real diseases
Authors: Michell A R 
Published: December 2008

Summary
Dogs are well established as experimental animals for the study of both renal disease and hypertension, but most work is based on surgical or pharmacological models and relatively little on spontaneous diseases. This review argues for the latter as an underexploited aspect of comparative medicine. The most important feature of canine hypertension may not be the ease with which models can be produced but the fact that dogs are actually rather resistant to hypertension, and perhaps to its effects, even when they have chronic renal failure. The importance of natural models of chronic renal failure is strengthened by the evidence that self-sustaining progression is a consequence of extreme nephron loss, that is, a late event, rather than the dominant feature of the course of the disease.
The role of salt in hypertension is discussed and emphasis given to the importance of understanding the physiological basis of nutritional requirement and recognizing that it is unlikely to exceed 0.6 mmol/kg/day for most healthy adult mammals except during pregnancy or lactation. Such a perspective is essential to the evaluation of experiments, whether in animals or humans, in order to avoid arbitrary definitions of 'high' or 'low' sodium intake, and the serious misinterpretations of data which result. An age-related rise in arterial pressure may well be a warning of excess salt intake, rather than a normal occurrence. Problems of defining hypertension in the face of variability of arterial pressure are also discussed.