bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fatal diltiazem overdose: report of four cases and review of the literature
Authors: Roper T A , Sykes R , Gray C 
Published: December 2008

Summary
Four fatal cases of diltiazem overdose are described and compared with previously published cases. Clinical sequelae include all grades of heart block, hypotension and ultimately death. Management includes gastric lavage and oral administration of activated charcoal at presentation. Further symptomatic treatment with inotropic agents and temporary cardiac pacing may be required. If these measures are successful, recovery occurs within 36 hours in uncomplicated cases. Toxicological data have been reviewed but currently drug levels can only offer a retrospective analysis of the severity of overdoses.
As the use and risk of abuse of diltiazem increases, these reports serve to highlight the possible hazards and to alert physicians to what must be regarded as a dangerous and potentially lethal drug in overdosage.
Takayasu's disease presenting as a nephrotic syndrome due to amyloidosis
Authors: Sousa Ana E , Lucas Margarida , Tavora Isabel , Victorino Rui M M 
Published: December 2008

Summary
We report an 18 year old black woman who presented with nephrotic syndrome in whom the investigations led to the diagnosis of diffuse Takayasu's disease, renal amyloidosis of AA type and interstitial lung disease. Proteinuria in Takayasu's disease is usually ascribed to hypertension or more rarely to glomerulonephritis. This case suggests that amyloidosis should be considered also in the investigation of proteinuria in these patients in view of the serious prognostic implications. This case represents further evidence that Takayasu's disease can be the cause of systemic reactive amyloidosis which may also be the presenting feature.
Primary lymphoma of the gallbladder
Authors: Friedman E P , Lazda E , Grant D , Davis J 
Published: December 2008

Summary
A case of primary lymphoma of the gallbladder is described which is rare in the medical literature. A 76 year old man presented with acute cholecystitis and septicaemia. Investigation showed a lung abscess and a gallbladder mass. The mass was thought to be an empyema and cholecystostomy was performed. Biopsy of the gallbladder wall showed high-grade B cell lymphoma. The patient unfortunately succumbed to overwhelming septicaemia in the postoperative period. Postmortem examination confirmed primary lymphoma of the gallbladder without dissemination.
Naftidrofuryl treatment for rest cramp
Authors: Young J B , Connolly M J 
Published: December 2008

SummaryA double-blind placebo-controlled study was carried out in 14 subjects to investigate the effect of naftidrofuryl in the treatment of rest cramp. Naftidrofuryl caused a significant reduction in cramp frequency (median naftidrofuryl = 5; median placebo = 17; P &lt; 0.004) and a significant 34% increase in cramp free days (median naftidrofuryl = 22; median placebo = 14; P &lt; 0.004). Naftidrofuryl is an effective alternative to quinine in the treatment of this painful condition.
Acquired C1 inhibitor deficiency with lymphoma causing recurrent angioedema
Authors: Mathur R , Toghill P J , Johnston I D A 
Published: December 2008

Summary
A 52 year old man who developed recurrent, massive and generalized angioedema for the first time during adult life was found to have an acquired deficiency of C1q esterase inhibitor (C1 INH) in association with a B cell lymphoma producing a paraprotein. He had low levels of C4 and C1 INH during the attacks which returned to normal after the successful treatment of lymphoma. An underlying lymphoproliferative disease should always be considered in adult patients with this immunological profile, recurrent angioedema and a negative family history.
Restless legs syndrome in the elderly
Authors: O'Keeffe S T , Noel J , Lavan J N 
Published: December 2008

Summary
The prevalence and significance of restless legs syndrome was assessed in 307 patients presenting to an acute-care geriatric medical service. Fifteen patients (5%) had restless legs syndrome; 13 (87%) of these patients had insomnia and 10 (67%) reported troublesome or frequent leg symptoms. Of 147 patients with current insomnia, iron deficiency (serum ferritin &lt; 18 ng/ml) was present in 4/13 (31%) patients with restless legs and 8/134 (6%) patients without restless legs (P &lt; 0.025). Improvement in symptoms of restless legs was noted with iron repletion.
These findings suggest that restless legs syndrome is relatively common in the elderly and causes significant discomfort and sleep disturbance. Iron deficiency is a common and treatable cause.
Homozygous variegate porphyria: an evolving clinical syndrome
Authors: Hift R J , Meissner P N , Todd G , Kirby P , Bilsland D , Collins P , Ferguson J , Moore M R 
Published: December 2008

Summary
Variegate porphyria is one of the most frequently encountered genetic conditions in South Africa. It is inherited as an autosomal dominant disease and in excess of 300 heterozygous cases have been studied by the Cape Town unit. Despite this, the homozygous condition has not previously been encountered in South Africa. We report two cases of homozygous variegate porphyria, one of whom represents the first South African case. We delineate a syndrome principally characterized by growth retardation, developmental delay, epileptic seizures, photosensitivity and an abnormal porphyrin excretion pattern. In addition we describe, in one case, two features not previously reported: skin disease in areas unexposed to light and a severe sensory neuropathy which may account at least in part for the hand deformities of this disorder.
Bancroftian filarial pleural effusion
Authors: Aggarwal Jyotima , Kapila Kusum , Gaur Abhishek , Wali Jyoti Prakash 
Published: December 2008

Summary
This paper describes a case of filarial pleural effusion, the fifth such to be reported. Microfilariae of Wuchereria bancrofti were detected in the pleural fluid on cytological examination. There was a prompt and complete response to treatment with diethylcarbamazine. There were, however, no symptoms and signs of tropical pulmonary eosinophilia nor any peripheral eosinophilia.
Cerebral infarction in association with Ecstasy abuse
Authors: Manchanda S , Connolly M J 
Published: December 2008

Summary
A previously fit 35 year old man presented with a right hemiparesis and dysphasia 36 hours after abuse of Ecstasy (3,4-methylenedioxymethamphetamine). Computerized axial tomography scan demonstrated an extensive acute left cerebral infarction and carotid digital subtraction angiogram, 2 days after admission, revealed left middle cerebral artery occlusion. There were no other known risk factors and all other investigations were negative. The patient made a partial recovery. We propose an association between Ecstasy abuse and cerebral infarction.
Candida lusitaniae causing fatal meningitis
Authors: Sarma P S A , Durairaj P , Padhye A A 
Published: December 2008

Summary
Fatal meningitis due to Candida lusitaniae in a 35 year old previously healthy man is described. C. lusitaniae is an opportunistic fungal pathogen reported infrequently in the English literature. This is the third case report of meningitis and the first fatal infection in an adult from Central India due to C. lusitaniae known to the authors.
Carcinoma of the breast at the site of migrated pacemaker generators
Authors: Bhandarkar D S , Bewu A D M , Taylor T V 
Published: December 2008

Summary
We report two patients in whom breast malignancy developed in the proximity of 'migrated' pacemaker generators. These cases and the similar ones reported in the literature raise concerns whether this association is merely coincidental or whether the pacemaker generator is responsible for the occurrence in some inexplicable manner. We urge for a routine, careful examination in all patients with implanted pacemaker generators at follow-up visits. This would help in (a) timely detection of migration of the pacemaker generators and (b) earlier diagnosis of any mass developing close to the migrated generators.
Sudden cardiac death and the potential role of beta-adrenoceptor-blocking drugs
Authors: Rajman Iris , Kendall Martin J 
Published: December 2008

Summary
Sudden cardiac death is a major health problem in the industrially developed countries. The risk of sudden cardiac death may be reduced by early detection of coronary heart disease, elimination of the risk factors, treatment of the ischaemia in patients known to have coronary heart disease and suppression of ventricular arrhythmias. Of all the therapeutic measures currently available to reduce the risk of sudden cardiac death, beta-adrenoceptor-blocking drugs (beta blockers) appear to be the most effective. In this paper their actions are reviewed and evidence for their efficacy is presented.
Spontaneous coronary artery dissection: a report of three cases and review of the literature
Authors: Kearney Peter , Singh Harsh , Hutter John , Khan Saleem , Lee Gary , Lucey James 
Published: December 2008

Summary
We describe the clinical course of three patients who developed spontaneous coronary artery dissection. All patients were young women, one 9 weeks pregnant. All presented with chest pain; one died suddenly proving refractory to resuscitation, another developed unstable angina culminating in myocardial infarction, cardiogenic shock and death, and the third patient underwent coronary artery bypass grafting following diagnosis of a spontaneous coronary dissection of the left anterior descending artery at angiography. Pathological findings in the two fatal cases are reported.
This condition, although rare, is a prominent cause of ischaemic coronary events in young women, when it is frequently associated with pregnancy or the puerperium. Most patients die suddenly, but a clinical spectrum is seen including stable and unstable angina, myocardial infarction and cardiogenic shock. The left anterior descending artery is most frequently affected. The classical histological finding is that of a large haematoma occupying the outer third of the media resulting in complete compression of the true lumen.
The cause of spontaneous dissection remains unclear but theories of aetiology include a medial eosinophilic angiitis, pregnancy-induced degeneration of collagen in conjunction with the stresses of parturition, and rupture of the vasal vasorum.
The diagnosis must be considered when a patient presents with a suggestive clinical profile. Urgent angiography should be undertaken to establish the diagnosis and consideration given to the need for coronary artery bypass grafting, which has been successfully employed in a number of patients. The uneventful long-term survival of cases treated conservatively has been reported.
A patient with coexisting narcolepsy and morbid jealousy showing favourable response to fluoxetine
Authors: Wing Yun-Kwok , Lee Sing , Chiu Helen F K , Ho Crover K W , Chen Char-Nie 
Published: December 2008

Summary
A 37 year old Chinese man suffered from coexisting narcolepsy and morbid jealousy which were precipitated by head injury 5 years previously. Fluoxetine 20 mg/day reduced his narcoleptic symptoms and morbid jealousy but not his sleepiness. On defaulting treatment, the patient's symptoms and marital problem recurred. A common central serotonin disturbance might be involved in mediating the sleep disorder and associated psychopathology.
Giardiasis of the stomach
Authors: Berney D M , Rampton D , van der Walt J D 
Published: December 2008

SummaryA patient with giardiasis in an inflamed gastric antral biopsy specimen is reported. Helicobacter pylori were not identified and no other cause of the gastritis was apparent. This condition may be more common than has been previously supposed and may be linked to bile reflux or hypochlorhydria.
The association of thrombocytopaenia and Lyme disease
Authors: Ballard Harold S , Bottino Gino , Bottino Joseph 
Published: December 2008

Summary
The association of asymptomatic thrombocytopaenia in six patients with acute Lyme disease is described. Recovery from thrombocytopaenia occurred shortly following antibiotic therapy. Patients residing in endemic areas for Lyme disease who present with flu-like symptoms and laboratory findings of thrombocytopaenia should prompt suspicion of acute Lyme disease. Appropriate clinical studies should be undertaken to confirm the diagnosis.
An acquired-pseudo Bernard Soulier syndrome occurring with autoimmune chronic active hepatitis and anti-cardiolipin antibody
Authors: Beales Ian L P 
Published: December 2008

Summary
A case of autoimmune chronic active hepatitis with unusual extrahepatic manifestations is described. The patient exhibited marked thrombocytopenia and platelet aggregation dysfunction and morphological changes suggesting an acquired Bernard Soulier-type syndrome. This has not previously been described in association with chronic active hepatitis. The patient also demonstrated significant titres of anti-cardiolipin antibodies. This is also a new finding in association with both the liver and platelet diseases. The platelet aggregation deficit was transferable in the patient's serum rather than being intrinsic to the platelets. The three previously reported cases of acquired Bernard Soulier are reviewed and possible mechanisms for the platelet dysfunction are discussed.
Subcutaneous apomorphine infusion in Parkinson's disease: does it have a role?
Authors: Muhiddin Khulood A , Roche Mary T , Pearce Vaughan R 
Published: December 2008

Summary
Apomorphine is a potent dopamine agonist at both D1 and D2 receptors and has been used successfully for treating the 'on/off' phenomenon in Parkinson's disease. We report our experience with apomorphine in treating the 'on/off' phenomenon in L-dopa responsive idiopathic Parkinson's disease. Thirteen such patients were commenced on apomorphine infusions. Their mean age was 69 (range 53-80) years and the mean duration of the disease was 15 (range 6-28) years. The clinical response to apomorphine was good in four patients, fair in two, unchanged in five and worse in two. Activities of daily living improved in six, were unchanged in five and worse in two. When the response was poor or showed no change, apomorphine was discontinued. In addition, apomorphine was also discontinued in three patients who had had a fair/good response but suffered side effects of hallucinations, delusions and psychosis, lack of cooperation or found the pump inconvenient. Apomorphine was continued in only three patients out of 13.
Impaired glucose tolerance and diabetes mellitus in a suburban Sri Lankan community
Authors: Fernando Devaka J S , Siribaddana Sisira , de Silva Deepthika 
Published: December 2008

Summary
The prevalence of impaired glucose tolerance and diabetes mellitus was studied in a suburban Sri Lankan community using 1985 WHO criteria. Oral 75 g glucose tolerance tests were performed on 633 subjects aged 30-64 years. The age-standardized prevalence rates for diabetes mellitus were 5.02 (95% CI 3.59-6.43) and impaired glucose tolerance 5.27 (95% CI 3.74-6.78). A total of 21% of diabetic patients were not known to have diabetes and were diagnosed for the first time during the survey. Obesity was more common (P &lt; 0.05) in diabetic patients (21%) when compared to non-diabetic subjects (10.5%). Diabetes mellitus is a common health problem in Sri Lanka, and there is a need for developing national policies for its prevention and control.
Anti-neutrophil cytoplasmic antibody-associated paraneoplastic vasculitis
Authors: Navarro J F , Quereda C , Rivera M , Navarro F J , Ortuño J 
Published: December 2008

Summary
A 68 year old man presented with a systemic necrotizing vasculitis and elevated levels of anti-neutrophil cytoplasmic antibody (ANCA) which responded to treatment with steroids and cyclophosphamide, with a decrease in the titre of ANCA until its disappearance. Four months later he presented with weakness, loss of weight, aphonia and dysphagia. A computerized tomography scan showed a solid mass in the anterior mediastinum, and histological studies revealed an undifferentiated adenocarcinoma. Vasculitis improved although the malignancy progressed and ANCA was persistently negative. Our case demonstrates an association between ANCA and paraneoplastic vasculitis.
Clinical contact preceding suicide
Authors: Obafunwa J O , Busuttil A 
Published: December 2008

Summary
Of the 400 consecutive completed suicides investigated over a 5-year period, 114 (28.5%) who had consulted a doctor in the week preceding death were specifically reviewed and compared with those who did not. The study comprised an analysis of the medical history, the scene of death and a complete autopsy with histological and toxicological examination and the identification of features which occurred more frequently in this group when compared with other suicides not contacting their doctors.
Suicide-associated factors include psychiatric illness (58.8%), deteriorating health (16.7%), and a loss of spouse (7.0%); all these features were manifested by this group of suicides more frequently than by those who made no clinical contact (P &lt; 0.001). A pre-indication of suicidal intention was made by 45% of these patients. This feature, as with previous attempts, occurred more commonly in patients who consulted a doctor (P &lt; 0.001).
Drug overdose was the most common suicidal method chosen (50.9%) and anti-depressants predominated (35%); 78% of those who overdosed ingested prescribed drugs. Poisoning was more common in this group (P &lt; 0.001).
Half of the victims committed suicide within 24 hours following consultation; of these, 51% overdosed on drugs with 61% of them ingesting their prescribed drugs. Of these 114 cases, the final consultation in 43% was to collect more drugs. All suicidal threats should be taken seriously, and particular care should be taken in prescribing and dispensing medication which may be fatal in overdose.
Improvement in glucose tolerance and beta-cell function in a patient with vitamin D deficiency during treatment with vitamin D
Authors: Kumar S , Davies M , Zakaria Y , Mawer E B , Gordon C , Olukoga A O , Boulton A J M 
Published: December 2008

Summary
Glucose metabolism was studied in a patient with vitamin D deficiency during its treatment with small doses of vitamin D. A continuous infusion of glucose test was performed to assess glucose tolerance and insulin sensitivity and beta-cell function were derived by mathematical modelling. Fasting glucose was 5.6 mmol/l and achieved glucose after the infusion was 10.4 mmol/l confirming diabetes.
The test was repeated 0.5, 1, 3 and 5 months after starting treatment. Serum calcium increased glucose intolerance from 1.76 to 2.0, 2.08, 1.96 and 2.0 mmol/l, respectively; vitamin D reached supraphysiological levels initially and returned to normal levels, and parathyroid hormone levels were normalized. Her weight did not change during treatment. Glucose tolerance improved during treatment and achieved glucose was 9.4, 8.6, 9.2 and 9.0 mmol/l at 0.5, 1, 3 and 5 months, respectively; insulin sensitivity did not change. Beta-cell function improved from 101% at diagnosis to 126%, 147%, 173% and 198% at 0.5, 1, 3 and 5 months, respectively.
Improvement in beta-cell function and consequently in glucose tolerance is likely to have been due to correction of hypocalcaemia, vitamin D deficiency and secondary hyperparathyroidism.
Malakoplakia of bone presenting as a pathological fracture
Authors: Tyagi Nirmala , Sherwani Rana , Sadiq S A , Maheshwari Veena , Abbas M , Tyagi S P 
Published: December 2008

Summary
A male aged 54 years presented with a pathological fracture of the right femur at the subtrochanteric level. The fracture site showed a lytic lesion with expansion of the bone, considered to be a metastasis. On histology, however, the area turned out to be malakoplakia of bone. The patient responded well to antibiotics and sulphonamides along with skeletal traction. This appears to be the fourth reported case of malakoplakia of bone.
Association between serum uric acid and some cardiovascular risk factors in a Chinese population
Authors: Woo J , Swaminathan R , Cockram C , Lau E , Chan A 
Published: December 2008

SummaryThe association between serum uric acid concentration and some cardiovascular risk factors was examined in a working Hong Kong Chinese population (mean age 38 years), consisting of 910 men and 603 women. There was no significant age-related rise in serum uric acid concentration. Positive associations were found between serum uric acid concentration and body mass index, waist hip ratio, systolic and diastolic blood pressure, urea, creatinine, protein, glucose (fasting and 2 hours after 75 g oral glucose load), 2 hour insulin, triglycerides, and apolipoprotein B in men. Similar, but fewer, associations were seen in women, with the addition of a positive association with age. In both sexes, serum uric acid was negatively associated with high-density lipoprotein cholesterol. These findings complement the well-known clinical association between gout and cardiovascular and metabolic diseases, such as hypertension, hyperlipidaemia and diabetes mellitus, and suggest that serum uric acid may be a marker for the presence of an adverse cardiovascular risk factor profile.
Side effects with amiodarone therapy
Authors: Shukla R , Jowett N I , Thompson D R , Pohl J E F 
Published: December 2008

Summary
Amiodarone hydrochloride is increasingly being used in the treatment of ventricular and supraventricular arrhythmias. Although a highly effective anti-arrhythmic agent, its use is restricted by the high incidence of side effects. To elucidate the value of monitoring serum level of both the parent drug and its active metabolite in predicting the occurrence of side effects, the investigators examined 109 patients from a register of patients treated with amiodarone for the prevalence of known side effects of the drug. The register contained over 90% of patients treated with amiodarone at the Leicester General Hospital during the period of the study.
The findings suggest cutaneous side effects and abnormal thyroid function tests (without overt gland dysfunction) are more likely to occur with increasing duration of treatment and cumulative dosage. However, neither the serum amiodarone level nor the serum metabolite level had any predictive power for the occurrence of side effects.
In view of this finding, it is recommended that close attention be paid to the continued clinical monitoring of side effects and that there is utility in measuring the serum amiodarone level in each patient to avoid the prescription of unnecessarily high doses. This is necessary not only to lessen the occurrence of cumulative dose-related side effects, but also because the variable but very long half-life of the drug leads to difficulties in relating spot drug levels to long-term effects.
Localized eosinophilic gastroenteritis with necrotizing granulomas presenting as acute abdomen
Authors: Fraile G , Rodríguez-García J L , Beni-Pérez R , Redondo C 
Published: December 2008

Summary
Eosinophilic gastroenteritis is a condition of unknown aetiology that has been frequently reported involving the stomach and bowel. The colon is rarely cited as a site for the condition. We report a patient suffering from allergic symptoms (asthma, atopic dermatitis, elevated serum IgE levels) who presented with colonic perforation due to eosinophilic colitis with necrotizing granulomas.