bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intermittent hypercalcaemia and vitamin D sensitivity in Hodgkin's disease
Authors: Karmali R , Barker S , Hewison M , Fraher L , Katz D R , O'Riordan J L H 
Published: December 2008

Summary
A patient with Hodgkin's disease spontaneously developed steroid-responsive hypercalcaemia during two consecutive summers. Administration of 3000 U/day of vitamin D, while he was normocalcaemic, caused a sharp increase in serum 1,25(OH)2D3 (from 59 pg/ml to 142 pg/ml) and subsequently hypercalcaemia while serum 25(OH)D3 rose moderately within the normal range (from 2.8 ng/ml to 10 ng/ml). During a spontaneous episode of hypercalcaemia which was accompanied by increased circulating 1,25(OH)2D3 concentrations, administration of hydrocortisone decreased serum 1,25(OH)2D3 rapidly (from 115 pg/ml to 62 pg/ml) and eventually led to normocalcaemia while serum 25(OH)D3 remained unchanged. Thus the disturbances of mineral metabolism found in this patient with Hodgkin's disease are very similar to those previously described in sarcoidosis.
A case of POEMS syndrome associated with essential thrombocythaemia and dermal mastocytosis
Authors: Jackson A , Burton I E 
Published: December 2008

SummaryWe describe a case of POEMS syndrome presenting with the recognized features of polyneuropathy, organomegaly, endocrine abnormalities, monoclonal protein, skin changes and anasarca. The patient was found to have both a solitary sclerotic plasmacytoma of the pelvis and evidence of Castleman's disease of lymph nodes. A number of unusual and unique features are also documented. Histological examination of affected skin demonstrated changes similar to urticaria pigmentosa including local oedema and mast cell infiltration. There was marked thrombocythaemia which has been seen in only one previous case and in addition the patient developed diffuse vascular calcification in the absence of recognized aetiological factors. Radiotherapy of the pelvic lesion and chemotherapy to control the myeloproliferative disorder gave rise to significant improvement in neuropathy. Control of anasarca required steroid therapy in addition to diuretics. The significance of these observations is discussed in relation to previous reports.
Endobronchial tuberculosis—is corticosteroid treatment useful? A report of 8 cases and review of the literature
Authors: Chan H S , Sun A , Hoheisel G B 
Published: December 2008

Summary
Eight patients with endobronchial tuberculosis diagnosed on bronchoscopy were treated with antituberculosis drugs and a course of prednisone. The progress of the endobronchial lesions was assessed on repeated examinations. The course of the disease was variable and the endobronchial narrowing improved in two patients only. Hypersensitivity reactions associated with initiation of antituberculosis treatment may constitute a special group where corticosteroid is indicated. In other situations, the usefulness of corticosteroid for treatment of endobronchial tuberculosis is not well documented.
Danazol in non-splenectomized patients with refractory idiopathic thrombocytopenic purpura
Authors: Edelmann D Z , Knobel B , Virag I , Meytes D 
Published: December 2008

Summary
Seven non-splenectomized patients with chronic refractory idiopathic thrombocytopenic purpura were treated with danazol 800 mg daily. All were glucocorticoid failures and four were refractory to all additional previous therapy. Five patients benefited from danazol and in two sustained normal platelet counts, for over 44 and 51 months, were observed. We conclude that danazol is useful for long term management of otherwise refractory idiopathic thrombocytopenic purpura. The advantage of danazol over splenectomy as a first line treatment in steroid failure is suggested.
Concomitant euthyroid Graves' ophthalmopathy and isolated ocular myasthenia gravis
Authors: Raef H , Ladinsky M , Arem R 
Published: December 2008

Summary
A 44 year old diabetic woman presented with diplopia and bilateral ptosis and mild exophthalmos. The patient was clinically euthyroid, the baseline thyroid function tests were normal, but the thyroid stimulating hormone response to thyrotrophin releasing hormone was flat. Computed tomographic scan and magnetic resonance imaging of the orbits showed left medial and inferior rectus muscle thickening, more prominent on the left side, consistent with Graves' disease. The tensilon stimulation test resulted in resolution of the ptosis and partial improvement of the ophthalmoplegia. The single fibre electromyography was consistent with a defect in neuromuscular transmission. However, forced duction test was normal and anti-acetylcholine receptor antibodies were undetectable. Significant improvement of the extraocular muscle function and resolution of the right ptosis had resulted from anticholinesterase therapy.
These findings and the clinical response to therapy were consistent with concomitant euthyroid Graves' ophthalmopathy and ocular myasthenia gravis. Coexistent isolated ocular myasthenia gravis and Graves' ophthalmopathy is rare and should be considered in patients with findings of ocular myasthenia and extraocular muscle dysfunction.
Typhoid hepatitis
Authors: Khosla S N 
Published: December 2008

SummaryLiver involvement in typhoid fever is uncommon. Typhoid hepatitis is now being recognized as a definite entity. Over a period of 4 years, we have observed 10 cases (4.8%) of typhoid hepatitis out of 210 cases of typhoid fever. Jaundice, anaemia, hepatomegaly and abnormal biochemical tests were present in all cases. Liver biopsy was done in 8 cases and was found to be abnormal in 5. Two of the 10 cases of typhoid hepatitis died.Recognition of typhoid hepatitis is important since it has to be differentiated from other common ailments in the tropics such as viral, malarial or amoebic hepatitis. Early institution of specific therapy in cases of typhoid hepatitis carries a good prognosis.
Withdrawal of maintenance digoxin from institutionalized elderly
Authors: Macarthur C 
Published: December 2008

Summary
Chronic use of digitalis is common amongst the institutionalized elderly. Associated with digitalis use is the potential for toxicity and/or adverse reactions. In this study maintenance digoxin was withdrawn from 14 elderly nursing home residents in sinus rhythm. Subjects were followed over 18 months for evidence of dysrhythmia or heart failure. One resident had an episode of supraventricular tachycardia which required digoxin to be restarted. One resident developed left heart failure, treated with oral diuretic. For 12 of the 14 residents, withdrawal of maintenance digoxin was achieved without deleterious effect. This study suggests that maintenance digoxin may be withdrawn safely in elderly nursing home residents in sinus rhythm and without history of atrial dysrhythmia.
Histiocytic cytophagic panniculitis
Authors: Hilton D A , O'Malley B P , Durrant S T S 
Published: December 2008

Summary
A 33 year old man developed fever, malaise, jaundice, pancytopenia, coagulation abnormalities, hepatomegaly, pleural effusions and a subcutaneous lump. Biopsies revealed a lobular panniculitis with the presence of cytophagic histiocytes; erythrophagocytosis was also demonstrated in the liver and bone marrow. Despite the use of chemotherapy (CHOP) his clinical condition deteriorated and he died 5 months after presentation. This illness is consistent with the recently described syndrome of histiocytic cytophagic panniculitis.
Cognitive impairment associated with beta-blockade in the elderly
Authors: Rogers T K , Bowman C E 
Published: December 2008

Summary
We report the cases of three elderly patients presenting with insidious mental impairment whilst receiving both lipophilic and hydrophilic beta-adrenoceptor blocking agents (propranolol and atenolol respectively). In each case marked improvement occurred on drug withdrawal. Two of our cases probably had early senile dementia of the Alzheimer's type and continued to exhibit signs of mild mental impairment, but the third was restored to normal functioning. We found no evidence of impaired perfusion to suggest a vascular basis for the effect or of depression. We believe that beta-blockade may cause or exacerbate mental impairment in the elderly.
Impact of endoscopic duodenal biopsy on the detection of small intestinal villous atrophy
Authors: Saverymuttu S H , Sabbat J , Burke M , Maxwell J D 
Published: December 2008

Summary
Coeliac disease is underdiagnosed partly because of insufficient recognition of more subtle presentations and partly because of the relative difficulty of jejunal biopsy. We have compared new case detection of small intestinal villous atrophy in the 5 years following changing to endoscopic multiple biopsy with our preceding 9 year experience utilizing jejunal capsule suction biopsy. The detection rate for small intestinal disease doubled while the number of patients investigated by small bowel biopsy increased threefold. We recommend that endoscopic duodenal biopsy replace jejunal biopsy for routine diagnostic purposes.
Caroli's disease misdiagnosed as hydatid liver cysts
Authors: Akoglu M , Davidson B R 
Published: December 2008

Summary
A 27 year old woman who presented with upper abdominal pain was found on ultrasonography to have multiple liver cysts consistent with hydatid disease. Three years previously she had undergone evacuation of multiple infected liver cysts thought to be due to hydatid disease. Computed tomographic scanning supported the diagnosis of hydatid disease affecting the right lobe of the liver. At laparotomy the right lobe contained multiple cysts which were removed by right lobectomy. Histology revealed congenital dilatation of the intrahepatic bile ducts with fibrosis (Caroli's disease) but no evidence of hydatid disease.
Acute rhabdomyolysis associated with atypical Guillain-Barré syndrome
Authors: Scott A J , Duncan R , Henderson L , Jamal G A , Kennedy P G E 
Published: December 2008

Summary
We report a patient with atypical Guillain-Barré syndrome associated with acute rhabdomyolysis. Rhabdomyolysis may be the cause of elevation of creatine kinase sometimes seen in patients with Guillain-Barré syndrome.
A case of resolving idiopathic hypoparathyroidism
Authors: Ostlere L , Reeve J 
Published: December 2008

Summary
A 72 year old man developed idiopathic hypoparathyroidism. The condition spontaneously resolved which, to our knowledge, has not been previously described. Causes of fluctuating hypocalcaemia are outlined and their possible relevance to our patient discussed.
Bilateral cilio-retinal artery occlusion in classic migraine
Authors: Hykin P G , Gartry D , Brazier D J , Graham E 
Published: December 2008

Summary
A case of bilateral cilio-retinal artery occlusion in a patient with classic migraine is described. It is unlikely that this hitherto unreported occurrence represents altered tone in the dense adrenergic innervation to the posterior ciliary circulation. We advise the continued use of beta-adrenergic blockers as prophylaxis in ocular migraine.
Alopecia totalis and vitiligo in common variable immunodeficiency
Authors: Spickett G , Prentice A G , Wallington T , Webster A D B , Chapel H 
Published: December 2008

Summary
Three cases of severe and irreversible alopecia occurring in patients with common variable immunodeficiency are described. In all three cases, hair loss developed after the diagnosis of immune deficiency; one of the patients also had extensive vitiligo. A fourth patient had vitiligo in the absence of alopecia. No change in the alopecia or vitiligo was noted in any patient as a result of immunoglobulin replacement therapy.
Disseminated gonococcal infection associated with deficiency of the second component of complement
Authors: McWhinney P H M , Langhorne P , Love W C , Whaley K 
Published: December 2008

Summary
A case of C2 deficiency presenting with disseminated gonococcal infection is described. The predisposition of C2-deficient individuals to infection in addition to the commoner problem of immune complex diseases is noted. Attention is drawn to the absence of documented cases of gonococcal infection associated with C2 deficiency. No other homozygous C2 deficient family members were identified. Lifelong penicillin prophylaxis was recommended for the patient.
Virilization in a postmenopausal woman due to ovarian stromal hyperthecosis
Authors: Goldman J M , Kapadia L J 
Published: December 2008

Summary
Virilization in women is occasionally caused by ovarian stromal hyperthecosis. Although three cases of post-menopausal women with hyperthecosis have been reported, the history in two of them strongly suggests a premenopausal origin. We describe a 64 year old woman with postmenopausal virilization due to bilateral ovarian stromal hyperthecosis.
Is the routine measurement of ionized calcium worthwhile in patients with cancer?
Authors: Riancho J A , Arjona R , Sanz J , Olmos J M , Valle R , Barceló J R , González-Macías J 
Published: December 2008

Summary
This study was undertaken to analyse the relationship between total calcium (TCa) and ionized calcium (ICa) in patients with cancer, and to assess the clinical value of routine measurements of ICa in these patients. Serum TCa, ICa, albumin, proteins and creatinine were measured in 188 adult patients with solid malignant tumours. Most of them were out-patients, the Karnofsky score being 80 or above in 67%. The correlation coefficient between ICa and TCa was 0.85 (P &lt; 0.001) and did not improve after correcting TCa for protein concentration with several published formulae. Although TCa measurements had a global diagnostic accuracy (percent of patients correctly classified) of 90%, they failed to identify a substantial proportion of patients with increased levels of ICa (57% for uncorrected TCa, and 27–57% for protein-corrected TCa). However, the finding of slightly increased ICa levels did not seem to predict the development of frank hypercalcaemia and did not impair the prognosis. According to these results, the routine measurement of ICa in unselected patients with cancer has no clinical usefulness.
Giant lymph node hyperplasia (Castleman's disease): a clinical study of eight patients
Authors: Baruch Y , Ben-Arie Y , Kerner H , Lorber M , Best L-A , Gershoni-Baruch R 
Published: December 2008

Summary
We report on 8 patients with giant lymph node hyperplasia (GLNH), diagnosed over a 10-year period. The age of the patients at diagnosis, the clinical presentation and the histological subtype varied, indicating that GNLH is a heterogeneous condition. One case was associated with liver cirrhosis, and in another patient bacterial endocarditis was diagnosed post mortem. Our study shows that GLNH is localized and benign in the young, and diffuse and aggressive in the elderly. It is concluded that GLNH should be separated into 3 clinical entities—namely, localized, systemic and reactive GLNH—defined by their clinical presentation and course, and correlated or not correlated with the histological findings.
Spontaneous external biliary fistula uncomplicated by gallstones
Authors: Birch B R P , Cox S J 
Published: December 2008

Summary
External biliary fistulae are rare. Only 65 cases have been reported in the literature and in each instance gallstones were a complicating factor. We report in this paper the first case of spontaneous external (cholecystocutaneous) biliary fistula uncomplicated by gallstones.
Ablation of recurrent primary liver cancer using 131I-lipiodol
Authors: Novell R , Hilson A , Hobbs K 
Published: December 2008

Summary
A case of recurrent hepatocellular carcinoma following resection is reported. The patient received 2 treatments of 131I-lipiodol administered via the hepatic artery at angiography. Good localization in tumour tissue was observed on subsequent computed tomographic scans and no adverse effects were seen after either treatment. After the first treatment 2 nodules of recurrent tumour were resected and proved to be totally necrotic. The patient remains well 9 months later with a persistently elevated serum alphafetoprotein but no evidence of residual tumour. It is suggested that 131I-lipiodol may be the treatment of choice for small tumours in elderly high-risk patients.
Hypoglycaemia associated with anorexia nervosa
Authors: Fonseca V , Ball S , Marks V , Havard C W H 
Published: December 2008

Summary
A 41 year old woman with severe emaciation due to longstanding anorexia nervosa presented with recurrent hypoglycaemia. During an episode of hypoglycaemia, serum insulin and C peptide were undetectable and plasma beta hydroxybutyrate, free fatty acids and lactate were inappropriately low. Response to intravenous glucagon was poor. Muscle enzymes were grossly elevated until she gained weight. Hypoglycaemia was abolished by weight gain.
Pulmonary embolism: a cause of acute confusion in the elderly
Authors: Shaw J E , Belfield P W 
Published: December 2008

Summary
Large numbers of elderly patients are admitted to hospital with an acute confusional state. In many of these, the underlying cause is easily found, but in a proportion, correct diagnosis is very difficult. Two cases of acute confusion due to hypoxia are presented, in which the diagnosis of pulmonary embolic disease was made late. The importance of considering this in all patients presenting with acute confusion and the value of blood gas analysis is discussed.
Transient hyperphosphatasaemia in association with acute infection in adults
Authors: Parker S G 
Published: December 2008

Summary
The causes of raised serum alkaline phosphatase were determined prospectively in a consecutive series of 2884 acute medical admissions. Diagnoses were established by pre-defined clinico-pathological criteria. Two hundred and four patients had hyperphosphatasaemia. Liver and bone disease accounted for only 98 (48%) of the established diagnoses. The diagnosis was not established in 31 (15%). Transient hyperphosphatasaemia occurred in 66 (32.4%) cases. In 25 of these patients (12% of the total) an acute infection was the sole illness identified. In this infected group, the isoenzyme type was predominantly hepatic, although jaundice occurred in only 3 patients. Discriminant analysis revealed that this group was characterized by haematological and biochemical features of an acute phase response.
Transient hyperphosphatasaemia is commonly found in acutely ill medical inpatients and is frequently associated with acute extrahepatic infection.
Hypernatraemia in an adult in-patient population
Authors: Long C A , Marin P , Bayer A J , Shetty H G M , Pathy M S J 
Published: December 2008

Summary
We report a retrospective study of hypernatraemia (serum sodium concentration &gt; 150 mmol/l) in an adult in-patient population of a health district during one year. The incidence was 0.3% with at least 60% of cases developing after hospital admission, mainly in elderly patients. Dehydration appeared to be the major cause, with the use of diuretics, depressed conscious level or febrile illness implicated in a majority. Most patients had more than one contributory factor and iatrogenic causes were common. Associated illnesses were often severe and the in-hospital mortality was high (54%) regardless of age. Hypernatraemia in hospitalized patients should be largely avoidable and there is a need for greater awareness of the importance of active maintenance of hydration in susceptible patients.
How reliable is the electrocardiogram in detecting left ventricular hypertrophy in hypertension?
Authors: Vijan S G , Manning G , Millar-Craig M W 
Published: December 2008

Summary
This paper assesses the sensitivity and specificity of the electrocardiogram in detecting left ventricular hypertrophy in 75 hypertensive patients. Each patient underwent a 12 lead electrocardiogram and echocardiogram. Left ventricular mass index, using echocardiogram, was calculated according to the Penn convention and left ventricular hypertrophy was assessed by standard electrocardiographic criteria.
The electrocardiogram was found to be very specific but insensitive in the detection of left ventricular hypertrophy as compared with the echocardiogram. Other non-voltage dependent markers appeared to have similar reliability.
We conclude that the electrocardiogram may be unreliable in the detection of left ventricular hypertrophy in hypertensive patients. Accurate assessment of left ventricular hypertrophy, in these patients should be by echocardiography.
Bradyarrhythmias in acute myocardial infarction: should thrombolysis lower the decision threshold for temporary pacing?
Authors: Lim C W , Bennie M J , Lim R 
Published: December 2008

Summary
Both acute myocardial infarction and reperfusion therapy with thrombolytic agents may be associated with bradyarrhythmias, and there may be a case for ‘prophylactic’ insertion of a temporary pacing wire in selected patients. We describe 4 patients in whom clinical decisions had to be made concerning the appropriateness and timing of temporary pacing, and discuss the implications for modern guidelines on the indications for pacing in such a setting.
Interaction of ketoprofen and frusemide in man
Authors: Wa T C L K , Lawson M , Jackson S H D , Hitoglou-Makedou A , Turner P 
Published: December 2008

Summary
The effects of ketoprofen on frusemide-induced diuresis, natriuresis and renin release were studied in 12 healthy male volunteers. Each received frusemide 40 mg once daily with either ketoprofen 100 mg twice daily or placebo for two periods of 5 days separated by a treatment-free period according to a randomized, double-blind, cross-over study design. Ketoprofen significantly reduced frusemide-induced diuresis on Day 1 but not on Day 5 of treatment. The natriuresis induced by frusemide on Day 1 or Day 5 of treatment did not differ significantly whether ketoprofen or placebo was administered, although the mean urinary sodium excretion values were consistently lower following ketoprofen. Ketoprofen did not affect the kaliuretic response to frusemide on Day 1 or Day 5 of treatment. The increase in plasma renin activity after frusemide was inhibited by ketoprofen on both Day 1 and Day 5. These results suggest that ketoprofen reduces the diuresis and renin release induced by frusemide, but that the reduction in diuretic response may become less important after their repeated coadministration.
Occult tuberculous postpneumonectomy space empyema four years after lung resection
Authors: Rogiers Ph , Verschakelen J , Knockaert D , Vanneste S 
Published: December 2008

Summary
We describe a patient in whom a tuberculous postpneumonectomy empyema developed 4 years after resection for lung cancer. The clinical presentation was dominated by non-specific constitutional symptoms, without any chest complaints. A computed tomographic scan of the chest suggested inflammation in the postpneumonectomy space. Ultimately Mycobacterium tuberculosis was cultured from material aspirated by needle thoracocentesis.
To our knowledge this is the first report of a tuberculous postpneumonectomy empyema complicating resection for cancer.
Gynaecomastia and extragonadal symptoms leading to diagnosis delay of germ cell tumours in young men
Authors: Cantwell B M J , Richardson P G G , Campbell S J 
Published: December 2008

Summary
We report two young men with gynaecomastia in whom the underlying causative metastatic germ cell malignancies were not diagnosed for prolonged time periods. Despite the fact that cancer is an uncommon cause of gynaecomastia, doctors should consider germ cell malignancy, even in the absence of testicular symptoms or signs, in previously healthy young men with recent gynaecomastia or other unusual symptoms or signs. Serum beta human chorionic gonadotrophin and other germ cell malignancy markers (alpha fetoprotein and lactic dehydrogenase) should always be assayed. If a testicular primary site is not clinically apparent, there should be early recourse to scrotal ultrasonography.