bluuebunny/crossref_metadata_2025_split huggingface dataset:
Combination products
Authors: Cromie B W 
Published: December 2008

Summary
Drugs that do not have a critical dosage and are commonly used together, can justifiably be combined in a single product. Such combinations are more convenient to doctor and patient and have reduced risk of treatment error and drug interaction.
Combination products include more than one active drug, each of which has its own chemical and physical properties, so that they are complex formulations. Copies of combination products are, therefore, even less likely to have comparable performance than copies of single drugs.
Generic copies are encouraged by pharmacopoeial monographs and the current inclusion of complex formulations and combinations in the BP may allow a new era of clinical non-equivalence from products considered to be generically equivalent.
The digoxin affair
Authors: Shaw T R D 
Published: December 2008

Summary
The cardiac glycosides are potentially dangerous medicines and consistent preparations are necessary. However, presently used tablets of digoxin differ markedly in the fraction of the dose which is absorbed. Measurement of plasma digoxin levels by radioimmunoassay show that absorption from the Lanoxin brand has varied considerably in recent years due to changes in manufacturing technique. Other brands marketed in the U.K. form a wide range of bio-availability. Hazards to the patient are not entirely avoided by brand name prescribing and it is suggested that new pharmacopoeial standards are needed.
Clinical pharmacology and therapeutics of the oesophagus and the lower oesophageal sphincter
Authors: Misiewicz J J 
Published: December 2008

Summary
Oesophageal function can be studied with intraluminal manometry, indwelling pH electrodes or with in vitro methods using isolated tissue. Radiology and endoscopy are the main diagnostic procedures. Innervation of the body of the oesophagus is mainly cholinergic, but the lower oesophageal sphincter appears to be affected by a wide range of biogenic substances, such as autonomic transmitters, polypeptide hormones and prostaglandins. Most drugs used in the treatment of oesophageal disorders act by modifying the action of the naturally occurring agents.
A comparison of beta adrenergic blocking drugs in the treatment of hypertension
Authors: Morgan T O , Anavekar S N , Sabto J , Louis W J , Doyle A E 
Published: December 2008

SummaryBeta adrenergic blocking drugs were found to be effective hypotensive agents in the long-term treatment of patients with hypertension. In 40% of patients they appeared to be an extremely satisfactory antihypertensive agent. The fall in blood pressure was confirmed in a double blind study which also indicated that propranolol, prindolol, alprenolol and MK 950 (timolol) had similar antihypertensive properties. Propranolol and timolol reduced the pulse rate more than prindolol and alprenolol but the fall in blood pressure induced by the four drugs was not significantly different. The incidence of volunteered side effects was low, but when questioned specifically a large number of patients has disturbance of their dream pattern. This was more frequent and severe with prindolol and alprenolol. In this study bronchospasm was associated with the use of propranolol and timolol but not with that of prindolol and alprenolol.In general, there is little difference between the various beta adrenergic blocking drugs in the treatment of hypertension, but in a few patients one or other may have advantages over the remainder. The dose ratios of the four drugs closely reflected their reported potency in producing beta adrenergic blockade. However, their exact mechanism of action is unknown, though it is probable that part of their effect is mediated via the central nervous system.
The use of anticoagulants in bacterial endocarditis
Authors: Kanis John A 
Published: December 2008

Summary
Early experience in the treatment of bacterial endocarditis with penicillin suggested that the addition of anticoagulants might improve results. This paper reports a patient with bacterial endocarditis who died from embolic cerebral damage after initiation of treatment with heparin. The evidence suggests that anticoagulants were responsible for her death and that bacterial endocarditis is a relative contra-indication to anticoagulant therapy.
Pathology with reference to the bile retention syndrome
Authors: Emery J L 
Published: December 2008

SummaryThe pathological significance of giant cells, inspissitated bile plugs and hepatic fibrosis in the liver of infants is critically reviewed. Evidence is presented suggesting that a wide variety of pathological change in the paediatric liver results from the interaction of the effects of growth, metabolic maturity, genetic metabolic variability and infection. Understanding of the bile retention syndromes might increase if the diagnosis of ‘Neonatal Hepatitis’ and ‘biliary atresia’ as finite conditions, were to cease and their pathogenesis considered in such a multifactorial way.
Bile salts and liver disease in childhood
Authors: Javitt Norman B 
Published: December 2008

SummaryRecognition of neonatal liver disease has been heavily dependent on the occurrence of jaundice. In most instances the jaundice is related to specific disturbances in bilirubin transport and other tests of liver function are normal. In contrast, hepatitis and other liver diseases not specifically affecting bilirubin transport often go undetected unless jaundice occurs.The development of practical methods for the estimation of bile acids in serum has permitted an evaluation of hepatic excretory function in neonates and children independent of bilirubin excretion. Since bile acid excretion by the liver each day greatly exceeds bilirubin excretion it was not surprising to find that elevations in serum bile acids occur regularly in anicteric hepatitis. Because the excretion of bile acids generates canalicular bile flow a reduction in the capacity to excrete bile acids intimates the presence of cholestasis. Early cholestasis is not associated with hyperbilirubinaemia but as cholestasis becomes more severe, jaundice occurs and the possibility of biliary atresia arises in neonates. Serum bile acid patterns in neonates being evaluated for biliary atresia indicate two distinctive patterns. Those infants with severe cholestasis and patent bile ducts usually have pre-dominantly cholic acid in serum. This observation is consistent with the bile acid patterns found in intrahepatic and extrahepatic cholestasis occurring in adult life. Infants found to have extrahepatic biliary atresia have marked elevations in the proportion of chenodeoxycholate in serum. Since elevations of chenodeoxycholate in serum are associated with hepatitis, the findings are consistent with the view that extrahepatic atresia is a rare sequalae of hepatitis.Studies of bile acid metabolism and excretion give promise of providing further insight on the pathogenesis of cholestatic liver disease.
Abnormal fatty acid composition and human atherosclerosis
Authors: Kingsbury K J , Brett C , Stovold R , Chapman A , Anderson J , Morgan D M 
Published: December 2008

Summary
Eighty patients with aorto-iliac / femoro-popliteal atherosclerosis were collected to examine in detail their plasma cholesteryl ester fatty acid compositions and to compare them with the incidence of ischaemic heart disease through a 4-year follow-up. Various other biochemical and rheological parameters were also measured to see if these might explain any association between the abnormal fatty acid pattern and ischaemic heart disease.
The abnormal fatty acid pattern was specifically and generally similar to that found in essential fatty acid (EFA) deficient animals and children as shown by the increase of the specific trienoic acid (C.20: 3ω9) by reduced linoleic acid concentrations, and by an increase of C.18 and C.16 monoenoic acids (oleic and palmitoleic), but not of their corresponding saturated forms, stearic and palmitic. The results suggest that the abnormal fatty acid composition resulted from an increased synthesis of monoenoic acids and monounsaturase activity, coupled with a relative inadequacy of linoleic acid.
The patients with a reduced concentration of linoleic acid (&lt;35%) subsequently had a higher incidence of myocardial infarction. No significant correlations were found between the fatty acid concentration and various other biochemical or rheological parameters except marginally between linoleic acid and platelet adhesiveness. Only the linoleic acid concentration distinguished between the patients with and without myocardial infarction.
A marked inverse correlation was found, however, between the monoenoic and linoleic acid concentration, without parallel changes in other fatty acids. It seems that as in animals, a balance exists between EFA and monoenoic pathways which are known to compete for the same desaturase systems and acyl sites. It appears that human EFA requirements and effects need to be considered not only by their intake and metabolism, but also through individual factors which vary the monoenoic concentrations and monounsaturase activity. Since these factors include several currently associated with human atherosclerosis the question arises of whether the EFA-monoenoic balance is one link between them and the pathology of the arterial occlusions and myocardial infarction.
Verapamil in the treatment of paroxysmal supraventricular tachycardia
Authors: Krikler Dennis M , Spurrell Roworth A J 
Published: December 2008

SummaryVerapamil is a novel antiarrhythmic agent which appears to act as a calcium-ion antagonist, blocking calcium transport across the myocardial cell membrane. It was given intravenously, in a dose of 10 mg, to thirty-two patients suffering from paroxysmal supraventricular tachycardia, and sinus rhythm was achieved promptly in all. Identical results were obtained in a further ten patients with supraventricular tachycardias associated with the Wolff-Parkinson-White or other pre-excitation syndromes. In a separate group of eighteen patients in whom A-V junctional tachycardias were induced during intracardiac electrography, conversion to sinus rhythm was achieved in fifteen patients, with prolongation of the cycle length in the others. Circus-movement tachycardias were induced in eight patients with the Wolff-Parkinson-White syndrome, and conversion to sinus rhythm was achieved in seven. The results were less consistent in patients with other supraventricular arrhythmias including ectopic atrial tachycardia and atrial flutter, and, in the single patient with supraventricular and ventricular tachycardia, only the former was controlled. In the single patient with atrial fibrillation complicating the Wolff-Parkinson-White syndrome who received verapamil, sinus rhythm was restored. Side effects were few and mild, with rare exceptions of profound hypotension, bradycardia and asystole; their management is discussed, and reasons are advanced why their occurrence is likely to be related either to the concomitant administration of beta-adrenergic blockers or to the presence of sinoatrial disease. It appears that verapamil is particularly suitable for the treatment of supraventricular tachycardias due to a circus movement as calcium antagonism is likely to be most effective in the N region of the atrioventricular node.
Gastro-bronchial fistula
Authors: Missen Anthony J B , Pemberton James , Boon Andrew 
Published: December 2008

Summary
1. Gastro-bronchial fistula is a rare condition occurring most commonly as a complication of a subphrenic abscess.
2. Other causes include trauma and necrosis within an infiltrating neoplasm.
3. The treatment of those fistulae which are secondary to a subphrenic abscess should be by drainage of the abscess, jejunal tube feeding and continuous gastric aspiration.
Aetiology of duodenal ulcer: an investigation into the buffering action and effect on pepsin of bran and unrefined carbohydrate foods
Authors: Tovey Frank I 
Published: December 2008

Summary
It is unlikely that any possible protective action of wheat or rice bran or certain unrefined grains against peptic ulceration is due to any acid or pepsin lowering effect. Although these substances contain significant amounts of buffer, they also act as antral stimulants resulting in increased acid output. They also have no inhibitory effect on pepsin activity.
Malignant mesothelioma invading the spinal canal
Authors: Cooper D 
Published: December 2008

Summary
A case of diffuse malignant pleural mesothelioma presenting as acute paraplegia is described. Autopsy revealed the presence of metastatic tumour within the spinal cord. An alveolar cell carcinoma coexisting with the mesothelioma and giving a distinct histological pattern was also present. There was no histological evidence of asbestos exposure.
Comparative clinical trial of diazepam with other conventional drugs in tetanus
Authors: Vassa Nalini T , Yajnik V H , Joshi K R , Doshi H V , Shah S S , Patel S H 
Published: December 2008

SummaryResults of therapeutic trial of diazepam in tetanus are presented. The trial included 200 cases of tetanus—167 non-neonates and thirty-three neonates. The patients were divided into two groups and were matched as regards age, sex and severity of the disease. The cases of group I received standard treatment while the cases of group II received diazepam in addition. Over-all mortality in group I was 54% and in group II, 26%. The results were statistically significant in non-neonates and in severe degree of tetanus. The drug was well tolerated and side effects were not observed.
Gonococcaemia with arthritis, dermatitis and myocarditis
Authors: Fraser H S , Figueroa J P , James O B O’L , Liburd A L , Nicholson G A , Whitbourne F , Alleyne G A O 
Published: December 2008

Summary
Six cases of gonococcaemia seen at the University Hospital of the West Indies are described. All presented with polyarthritis and all but one had skin lesions. They varied widely in severity and chronicity and included one case with rigors and myocarditis. Emphasis is placed on the diagnostic value of the scanty skin lesions, and the importance of repeated examination of cervical swabs.
Bumetanide—acute and long term studies of a new high potency diuretic
Authors: Murdoch W R , Auld W H R 
Published: December 2008

SummaryThe properties of a new diuretic, bumetanide, were investigated in ten normal volunteers, and sixty-eight patients with fluid retention. It had a rapid action virtually complete in 4 hr with an effect on water and electrolyte excretion similar to that of frusemide. It was highly potent, 1 mg producing an effect comparable to 48 mg frusemide in normal subjects, and about 40 mg in oedematous subjects in controlled short-term experiments. In long-term studies in forty-eight patients extending over periods up to 51 weeks it was found to be effective in controlling oedema. There was a low incidence of electrolyte complications and no other biochemical abnormalities or haematological complications were attributed to the drug. Bumetanide was well tolerated by patients. A drug rash was observed in two cases.
Prostaglandin levels in blood plasma during asthmatic attacks in patients with aspirin idiosyncrasy
Authors: Delaney J C , Smith J B , Silver M J 
Published: December 2008

Summary
It has been suggested that prostaglandin release is an important factor in the pathogenesis of bronchial asthma. Aspirin inhibits prostaglandin synthesis, yet there are a group of patients, with aspirin idiosyncrasy, who develop asthma after ingestion of aspirin. We measured prostaglandin levels in seven individuals with this syndrome. Only trace amounts of PGE2 and PGF2α were found in plasma during asthmatic attacks provoked by aspirin.
Primary biliary cirrhosis in brothers
Authors: Bown R , Clark M L , Doniach D 
Published: December 2008

Summary
This is the first report of two brothers who demonstrated the classical clinical course, histology, biochemistry and auto-antibodies of primary biliary cirrhosis. Both also exhibited an associated keratoconjunctivitis sicca and, in one, renal tubular acidosis resulted in severe systemic acidosis after lactulose therapy and with a subsequent intraperitoneal variceal rupture.
Screening of the relatives recalled a high incidence of ‘auto-immune’ disease and auto-antibodies.
Metabolic responses to selective β-adrenergic stimulation in man
Authors: Goldberg R , Joffe B I , Bersohn I , van As M , Krut L , Seftel H C 
Published: December 2008

SummaryThe responses of plasma free fatty acid, glucose, lactate, insulin and growth hormone to intravenous administration of the predominantly β-2 stimulant, salbutamol, were studied in nine normal subjects. Four subjects received the predominantly β-1 blocking agent, practolol, together with salbutamol.Salbutamol produced a marked rise in free fatty acid levels and there was also an appreciable increase in insulin values; lactate levels rose moderately and glucose values increased slightly; growth hormone levels were not affected. Practolol did not alter the free fatty acid response; it diminished but did not appear to abolish the insulin response, and it appeared to suppress the lactate and glucose rises.Tentative proposals are made regarding the nature of the β-receptor subtypes responsible for mediating these effects; most definite is the suggestion that lipolysis is subserved by β-2 receptors. Possible clinical implications are briefly discussed.
The response to luteinizing hormone-releasing hormone in normal men
Authors: Shahmanesh M , Ellwood M , Nelson Eva , Boyns A R , Groom G V , Hartog M 
Published: December 2008

SummarySynthetic luteinizing hormone-releasing hormone (LH-RH) was given in doses of 11-100 μg to normal men. Doses of 50 and 100 μg caused a two- to ten-fold rise in serum LH in all subjects, but in only 40% was the serum follicle-stimulating hormone (FSH) elevated. A significantly higher LH response to LH-RH was seen in subjects in whom a rise in serum FSH could be detected. Although there was a wide variation in the serum gonadotrophic hormone response, the test was reproducible in individual subjects. A significant rise of serum LH was seen following the injection of 1 μg LH-RH and a linear log-dose response occurred over the range 0·25 to 4 μg. There was no rise in serum FSH with the lower doses of LH-RH. Two injections of LH-RH 90 min apart produced comparable rises of serum LH and FSH. The rise of serum LH following a second injection of LH-RH was blunted when the two injections were given 30 or 45 min apart.
Primary thyroid failure presenting as a pituitary tumour
Authors: Daggett P , Kuku S F , Harsoulis P , Pearse E E , Fraser T R 
Published: December 2008

Summary
A 20-year-old female was referred as a pituitary tumour with failure to grow. Primary hypothyroidism from the age of 8 had been diagnosed at the age of 11, when the patient was put on thyroid replacement therapy. Routine investigations showed normal anterior pituitary function, and confirmed the diagnosis of primary hypothyroidism. A needle biopsy of the pituitary gland revealed an empty fossa. The possible relation of the empty sella with the primary hypothyroidism is discussed. A chromosome anomaly, deletion of the short arm of an X chromosome, was found and its contribution to the delayed growth is discussed.
The flora of the respiratory tract in chronic disease
Authors: May J Robert 
Published: December 2008

Summary
Assessment of the significance of the presence or absence of pathogenic bacteria in sputum specimens is made difficult by a number of factors which are discussed. It is now generally accepted that Haemophilus influenzae is the organism most commonly responsible for recurrent or persistent sputum purulence in chronic lower respiratory disease. The close association between this organism and chronic bronchitis has been confirmed by studies of precipitin antibodies. In patients with cystic fibrosis precipitin antibodies to Pseudomonas aeruginosa and Staphylococcus aureus are frequently present: they are less commonly found in patients with bronchiectasis and very rarely in patients with chronic bronchitis.
The cardiomyopathy associated with methylsalicylate
Authors: Ojiambo Hillary P 
Published: December 2008

SummaryDogs challenged with toxic doses of methylsalicylate developed acute myocardiopathy. Metabolic manifestations of uncoupling of oxidative phosphorylation by methylsalicylate (MS) were observed. Oxygen consumption increased two-fold. The haemodynamic abnormalities produced by intervention were minimal. The measured metabolic parameters indicated profound derangement. A net efflux of orthophosphate, lactate and potassium was observed from the myocardium. Marked hyperkalaemia occurred terminally. Morphological changes were observed on electron microscopy.
The possibility of dietary protective factors in duodenal ulcer
Authors: Tovey F I , Jayaraj A Paul , Clark C G 
Published: December 2008

SummaryRats fed on a supplement of raw cabbage, brinjal, dhal or powdered milk given in addition to a staple rice or laboratory stock diet show a high degree of protection against experimental ulceration following pyloric ligation. Wheat bran and ragi (a millet) conferred some protection, whereas rice bran and maize conferred no protection. The protection conferred by raw cabbage was destroyed by cooking. The lettuce used conferred no protection. The significance of such findings with regard to the geographical distribution of duodenal ulcer in India and Africa is discussed.
Serum lipid changes following the completed stroke syndrome
Authors: Hollanders F D , Shafar J , Burton P 
Published: December 2008

Summary
Levels of serum cholesterol and M-particle lipoprotein have been monitored in twenty-six patients after the onset of the completed stroke syndrome. Measurements were made regularly over the first 4 weeks and again at 3 months. A steady fall in serum cholesterol was noted which evened out after the ninth day and returned to the original level by the third month. M-particle lipoprotein showed no change in the first 4 weeks but a significant rise over the original level was demonstrated at 3 months.
Some implications of these findings are discussed and it is concluded that, if required, valid serum cholesterol measurements can be made following the completed stroke syndrome provided the blood sample is withdrawn within 24 hr of the acute episode. These findings accord well with those after myocardial infarction.
Carpal tunnel syndrome in patients on intermittent haemodialysis
Authors: Warren D J , Otieno L S 
Published: December 2008

Summary
Twenty-three out of thirty-six patients using a forearm arteriovenous fistula for dialysis reported symptoms of carpal tunnel syndrome in the fistula hand during dialysis. By contrast with other reported groups of patients with the syndrome, symptoms were common in male patients, and confined to the non-dominant (fistula) hand. Predialysis venous pressure in the hand and hand volume were increased on the side of the fistula, and increasing hand volume during dialysis was associated with the development of symptoms of carpal tunnel syndrome. Severe symptoms during dialysis necessitated carpal tunnel decompression in two male patients. Measures to reduce the incidence of this complication of arteriovenous fistulae in dialysis patients are discussed.