bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lipohypertrophy and lipoatrophy complicating treatment with highly purified bovine and porcine insulins
Authors: McNally P G , Jowett N I , Kurinczuk J J , Peck R W , Hearnshaw J R 
Published: December 2008

Summary
Lipoatrophy and lipohypertrophy were the most frequently reported local complications of conventional insulin therapy. Early reports following the introduction of highly purified insulins suggested a reduction in the frequency of lipohypertrophy and lipoatrophy. Since highly purified insulins have been in common usage for 10 years, the present frequency of these complications was assessed in a study of 281 insulin treated diabetics. Lipohypertrophy was recorded in 76 (27.1%) patients including 3 with associated lipoatrophy. Lipoatrophy was found in 7 (2.5%) cases (3 porcine and 4 bovine insulin treated), 4 of which had only ever used highly purified insulins. Despite the introduction of highly purified insulins, lipohypertrophy and lipoatrophy remain prevalent in insulin treated patients. This common complication may be limited by routinely inspecting injection sites.
Rapid urease test provides specific identification of Campylobacter pylori in antral mucosal biopsies
Authors: Szeto M L , Pounder R E , Hamilton-Dutoit S J , Dhillon A P 
Published: December 2008

Summary
In a prospective study, three antral biopsies were taken from 175 dyspeptic patients during routine endoscopy. One biopsy was inserted immediately into a gel-containing well of a CLOtest slide and two biopsies were sent to histopathology. Using the CLOtest, 84 of the 175 samples (48%) detected urease activity in the gastric biopsy, suggesting infection with Campylobacter pylori. Histopathological examination by two independent observers reported that 93 (52%) of the biopsies contained Campylobacter-like organisms. The CLOtest was found to have a specificity of 1.0 and sensitivity of 0.91, providing a rapid identification of most patients harbouring the organism in their gastric mucus.
Porphyria cutanea tarda in association with the human immunodeficiency virus infection
Authors: Ong E L C , Ellis M E , McDowell D , Gebril M , Weinkove C , Ead R 
Published: December 2008

Summary
A 42 year old heterosexual male with symptomatic human immunodeficiency virus infection presented with a 2-week history of tense blistering skin lesions following azidothymidine therapy. Urinary porphyrin excretion confirmed the diagnosis of porphyria cutanea tarda. The blisters resolved following the withdrawal of the drug but recurred when rechallenged. Three other cases of porphyria cutanea tarda, not associated with azidothymidine, who subsequently developed acquired immunodeficiency syndrome have recently been described. If azidothymidine is not the precipitating agent, it is possible that human immunodeficiency virus itself can impair porphyrin metabolism, leading to the clinical and biochemical features of porphyria cutanea tarda.
How do we know who has had deep vein thrombosis?
Authors: Sandler D A , Mitchell J R A 
Published: December 2008

Summary
An attempt was made to identify all patients diagnosed as having deep vein thrombosis (DVT) in a large teaching hospital during one year. A review of the radiology records showed that 124 (81%) of the 154 venograms performed were for suspected DVT, and that the diagnosis was confirmed in 57 (46%). During the same period, the Hospital Activity Analysis (HAA) records revealed 174 episodes classified as ‘phlebitis or thrombophlebitis’ in 162 patients. Only 37 of these episodes (21%) had been confirmed by X-ray venography and at least 29 patients were incorrectly classified by HAA. ‘Medical’ patients accounted for 54% of the episodes of DVT, yet in only 25% of these was the diagnosis confirmed by venography, while ‘surgical’ DVTs were less frequent but were more often confirmed by venography.
The black thyroid: an unusual finding during neck exploration
Authors: Noble J G , Christmas T J , Chapple C , Katz D , Milroy E J G 
Published: December 2008

Summary
Black thyroid discolouration has been reported in post-mortem examinations on patients who have previously taken minocycline. The discovery of this phenomenon during neck exploration and a review of the possible mechanism of black thyroid discolouration are discussed in this paper.
Transvenous pacemaker electrodes placed unintentionally in the left ventricle: three cases
Authors: Winner S J , Boon N A 
Published: December 2008

Abstract
Three patients are described in whom pacemaker electrodes were unintentionally placed within the left ventricle, followed by considerable delay before the error was recognized. In two cases temporary pacemaker wires were inserted into the subclavian artery and passed along a retrograde course. One patient required urgent surgery for acute arterial obstruction on removal of the wire. In the third case, a permanent wire was inserted correctly into a vein but traversed the atrial septum, probably via a patent foramen ovale, to enter the left ventricle. Twelve lead electrocardiograms in all three patients showed paced complexes with right bundle branch block configuration. This appearance should raise suspicion that the pacemaker electrode might be in the left ventricle, in which case its position should be defined by chest radiographs (including a lateral view) and echocardiography.
Anticardiolipin antibody levels in diabetic subjects with and without coronary artery disease
Authors: Hendra T J , Baguley E , Harris E N , Khamashta M H , Trembath R C , Hughes G R V , Yudkin J S 
Published: December 2008

Summary
Moderate (greater than 20 units) and high (greater than 80 units) IgG anticardiolipin antibody (aCL) titres are strongly predictive for recurrent thrombosis and early myocardial infarction in non-diabetic subjects. We have tested the hypothesis that the excess risk of myocardial infarction in diabetic subjects relates to the presence of aCL by measuring the frequency and titre of aCL in two groups of diabetic subjects and in 2500 healthy controls. One non-diabetic subject (0.04%) had low (5-20 units) IgG aCL titres. Seven out of 126 diabetics without cardiovascular disease (5.6%) and 9 out of 79 diabetics who were either myocardial infarction survivors or who had angiographically-proven coronary artery disease (11.4%) had low aCL titres (P less than 0.01 for comparison of either diabetic group with controls, and P less than 0.1 for comparison between diabetic groups). One subject in each diabetic group, but no non-diabetics, had moderate IgM aCL titres. No subjects had high aCL titres. Diabetics have an increased frequency of low aCL titres which may relate to macrovascular disease. Macrovascular disease in diabetics is not associated with moderate or high aCL titres.
False aneurysm formation after Salmonella virchow infection of a pre-existent ventricular aneurysm--survival after surgical resection
Authors: Echevarria S , Arjona R , Alonso J , Riancho J A , Revuelta J M , Macias J G 
Published: December 2008

Summary
A 55 year old man with a left ventricular aneurysm, secondary to a previous myocardial infarction, was hospitalized due to a Salmonella virchow bacteraemia. During a 3-week hospital course he was persistently bacteraemic and febrile despite antibiotic treatment. Gallium isotope scanning and 2-D-echocardiography were helpful in demonstrating the presence of an infected false aneurysm at the site of a true aneurysm. Surgical resection in addition to prolonged antibiotic therapy was necessary for cure.
Hyperthyrotrophinaemia during thyroxine replacement therapy
Authors: McClelland P , Stott A , Howel-Evans W 
Published: December 2008

SummaryDuring the follow-up of 224 cases of treated hypothyroidism, 14 clinically euthyroid patients were found to have elevated serum thyrotrophin and normal total thyroxine concentrations. Closer observation of these patients during the following 27 months resulted in the serum thyrotrophin levels returning to normal spontaneously in 8 patients (Group 1) whilst remaining elevated in 6 (Group 2), despite no significant differences in thyroid hormone levels between the two groups. Serum thyrotrophin in Group 2 patients remained high until an additional 50 micrograms/day thyroxine was prescribed although only 2 patients noted any benefit. Non-compliance or inadequate dosage of thyroxine are the probable causes of this sub-clinical hypothyroidism. Thyroid hormone estimations fail to differentiate the two conditions and we recommend a period of closer observation before making any thyroxine dosage adjustments in order to detect non-compliance.
Haemophagocytic syndrome complicating acute lymphoblastic leukaemia
Authors: Stark R , Manoharan A 
Published: December 2008

SummaryA 41 year old female developed reactive haemophagocytic histiocytosis secondary to herpes simplex infection, during remission induction for acute lymphoblastic leukaemia. She recovered fully with acyclovir and supportive treatment. Previous publications on the association between acute lymphoblastic leukaemia and haemophagocytic syndrome are reviewed, and the nature of the haemophagocytic disorder is discussed.
Oesophageal ulcer caused by warfarin
Authors: Loft D E , Stubington S , Clark C , Rees W D 
Published: December 2008

Summary
Oesophageal injury is a well recognized complication of certain oral medications but warfarin has not been implicated previously. We present a case of an oesophageal ulcer occurring in a patient with mitral regurgitation taking warfarin, and demonstrate a delayed oesophageal tablet transit time.
Foreign body aspiration in the adult: an occult cause of chronic pulmonary symptoms
Authors: Ben-Dov I , Aelony Y 
Published: December 2008

Summary
We describe two otherwise healthy subjects with many years sequelae due to lung aspiration. In both, diagnosis was delayed due to lack of history of aspiration. Recurrent pneumonia in the same segment in one, and migratory pneumonia in the other, could have suggested the diagnosis.
Review of the literature shows that occult foreign body aspiration poses difficulties in diagnosis and that often a history of aspiration is lacking. However, the recurrent nature and the localization of the pneumonia, as well as the findings during bronchoscopy, should alert the physician to the possibility of foreign body aspiration.
Hypothyroidism and unusual rickets in a very preterm infant
Authors: Macmahon P , Blair M , Kovar I 
Published: December 2008

SummaryTwo separate episodes of rickets developed in a female infant of 25 weeks gestation and birthweight 690 g, who had congenital hypothyroidism and required parenteral nutrition for more than 100 days. We speculate that there is a relationship between metabolic bone disease of prematurity and the preterm infant’s thyroid status.
Severe, self-limiting lactic acidosis and rhabdomyolysis accompanying convulsions
Authors: Winocour P H , Waise A , Young G , Moriarty K J 
Published: December 2008

Summary
A 26 year old man with no previous history of convulsions presented in status epilepticus and severe lactic acidosis. He regained consciousness and the acidosis resolved after several hours of conservative management without intravenous bicarbonate, but he developed severe myalgia associated with marked elevation of creatine kinase and moderate raised plasma creatinine levels which resolved spontaneously after 3 days.
Severe lactic acidosis and rhabdomyolysis may accompany status epilepticus, although they appear to be self-limiting without important sequelae.
Cyclosporin treatment of a woman with acquired haemophilia due to factor VIII:C inhibitor
Authors: Pfliegler G , Boda Z , Hársfalvi J , Flóra-Nagy M , Sári B , Pecze K , Rak K 
Published: December 2008

Summary
A 47 year old woman is reported who had life-threatening bleeding due to the spontaneous development of factor VIII:C inhibitor. Cyclosporin combined with prednisone resulted in a full recovery and complete elimination of antibody even when other therapeutic facilities failed to be effective.
Asthma in pregnancy complicated by iatrogenic pulmonary oedema
Authors: Hardy C C , Lorigan P , Ratcliffe A , Carroll K B 
Published: December 2008

Summary
We report a unique case of near fatal acute pulmonary oedema developing with intravenous ritodrine, given in an attempt to suppress premature labour. The novel aspect of the case is that the patient had also been treated in the previous week with high dose nebulized beta-agonists for an episode of acute severe asthma, demonstrating that this idiosyncratic reaction to beta-adrenergic agents only occurs with the intravenous route of administration. The management of acute severe asthma occurring in pregnancy is discussed with a review of previous literature regarding possible mechanisms of beta 2-agonist-induced pulmonary oedema.
Purulent pericarditis
Authors: Hall I P 
Published: December 2008

Summary
Purulent pericarditis is an infrequent, but important complication of infective illnesses, in particular pneumonia, which if diagnosed early has a good prognosis. The incidence of the condition is probably increasing, particularly in the immuno-compromised group of patients. ‘Classical’ symptoms and signs are often absent, and a high index of awareness is required to diagnose the condition. This review deals with the epidemiology, microbiology, clinical features, treatment and prognosis of purulent pericarditis with two illustrative examples of typical cases.
Cardiac arrhythmias during acute exacerbations of chronic airflow limitation: effect of fall in plasma potassium concentration induced by nebulised beta 2-agonist therapy
Authors: Lim R , Walshaw M J , Saltissi S , Hind C R K 
Published: December 2008

Summary
The effect on cardiac rhythm of the fall in plasma potassium concentration induced by nebulised beta2-agonist therapy was studied in 20 patients admitted to hospital with an acute exacerbation of their reversible chronic airflow limitation. Arrhythmias considered serious or potentially life-threatening were recorded in 13 patients (65%). However, there was no significant increase in these arrhythmias in the hour following administration of nebulised beta2-agonist despite a significant fall in plasma potassium concentration during this period.
Thrombocytopenia--radial aplasia (TAR) syndrome with associated immune thrombocytopenia
Authors: O’Flanagan S J , Cunningham J M , McManus S , Otridge B W , McManus F 
Published: December 2008

Summary
We report a 10 year old girl with congenital thrombocytopenia with absent radii (TAR) syndrome. Unusually this patient has shown no abnormal bleeding tendency despite numerous orthopaedic procedures. There is evidence of an associated immune component to the thrombocytopenia which has not been previously documented.
Spontaneous resolution of cervical spinal epidural haematoma
Authors: Anderson T J , Donaldson I MacG 
Published: December 2008

Summary
A patient with a spontaneous cervical spinal epidural haematoma is described. Surgical decompression is generally regarded as mandatory. There was complete clinical and radiological resolution with non-operative treatment. This is the fifth recorded case of spontaneous resolution of spinal epidural haematoma. In selected patients with incomplete and non-progressing deficit, conservative management may be possible.
Microscopic polyarteritis: clinical features and treatment
Authors: Rodgers H , Guthrie J A , Brownjohn A M , Turney J H 
Published: December 2008

Summary
The clinical features, treatment and survival of 36 patients with microscopic polyarteritis diagnosed between 1957-1988 have been reviewed. All had a focal segmental necrotizing glomerulonephritis on renal biopsy with evidence of a small vessel vasculitis. Most had a prodromal illness of less than 1 month. Severity of renal disease varied from microscopic haematuria which has a good prognosis to acute oliguric renal failure which carries a high mortality. The prognosis of microscopic polyarteritis can be improved if the condition is recognized early and treated with steroids and cyclophosphamide.
Combined anti-arrhythmic therapy with class 1 and class 3 drugs
Authors: James M A , Papouchado P , Jones J V 
Published: December 2008

Summary
This study was designed to investigate the differences in efficacy between 3 different combinations of amiodarone and a class 1 anti-arrhythmic drug (one from each class). The purpose was to determine whether the known differing electrophysiological properties of class 1 drugs result in any particular one making a superior combination with the class 3 drug amiodarone. Eight patients were studied in a randomized single blind cross-over trial. Amiodarone and flecainide proved to be the superior combination producing a significantly greater reduction in mean ectopic counts/24 hours than the amiodarone/mexilitene combination (1,286 vs 3,243; P less than 0.05) or the amiodarone/disopyramide combination (3,795; P less than 0.05). All 3 combinations reduced mean ectopic counts from the baseline value (8,729), but this was only significant for amiodarone/flecainide (P less than 0.01) and amiodarone/mexilitene (P less than 0.05). In addition the amiodarone/flecainide combination produced a significant reduction in complex forms of arrhythmia with ventricular tachycardia abolished in all cases, which was not achieved by any other combination.
Psychiatric morbidity in primary hyperparathyroidism
Authors: McAllion S J , Paterson C R 
Published: December 2008

SummaryPsychiatric symptoms are well recognized as a feature of patients with primary hyperparathyroidism. We have applied a standardized psychiatric interview to 15 patients before and after surgery. Thirteen had a lower ‘psychiatric score’ (less psychiatric morbidity) after surgery and improvements were particularly seen in symptoms of fatigue, depression, irritability, sleep disturbance and lack of concentration. The levels of intellectual impairment and of anxiety were unchanged after surgery. The ‘psychiatric scores’ in an additional group of 21 hyperparathyroid patients, in whom a decision to treat conservatively had been made independently, were similar to those in the surgically treated patients after surgery. Among all the untreated patients no relationship was found between overall ‘psychiatric score’ and serum levels of calcium or parathyrin.
Coexistent Crohn’s disease and sigmoid diverticulosis
Authors: McCue J , Coppen M J , Rasbridge S A , Lock M R 
Published: December 2008

Summary
This study reports six patients with a diagnosis of diverticular disease with associated localized Crohn’s colitis who were all treated by segmental resection. Two patients died in the post-operative period from disease unrelated to their colonic pathology. The remaining four patients remain well, show no signs of recurrent disease and have required no further surgery. The behaviour and significance of the two conditions occurring in the same patient is discussed.
Bilateral adrenal lymphoma presenting as Addison’s disease
Authors: Pagliuca A , Gillett D S , Salisbury J R , Basu R N , Mufti G J 
Published: December 2008

Summary
We describe an unusual case of non-Hodgkin’s lymphoma of the adrenals which presented as Addison’s disease. Examination of tissue taken by computed tomography guided biopsy revealed a high grade B cell centroblastic lymphoma. The patient was treated with chemotherapy but died from invasive aspergillosis. Autopsy confirmed bilateral adrenal involvement by lymphoma.
Testicular cancer in three brothers
Authors: Raina V , Young P T , Soukop M 
Published: December 2008

Summary
Three of four brothers in a family were diagnosed to have testicular tumour. All brothers were in their twenties at diagnosis and all had malignant teratoma, intermediate. One of the brothers, in addition, had a seminoma on the same side as the teratoma. The cases were unusual as there was no family history of cancer and no congenital abnormalities, such as cryptorchidism. Chromosomal analysis and HLA typing did not help in elucidating the cause of this rare familial occurrence of testicular tumour.
Increasing age, diabetes mellitus and recovery from stroke
Authors: Gray C S , French J M , Bates D , Cartlidge N E F , Venables G S , James O F W 
Published: December 2008

SummaryIn a prospective study of 200 patients with acute stroke, blood glucose and glycated haemoglobin (HbA1) were measured within 72 hours of onset. Unrecognized hyperglycaemia as defined by a raised stable HbA1 more than two s.d. above the mean reference value and no previous history of diabetes was present in 27%. No correlation existed between patient age and admission blood glucose or HbA1 levels (r = 0.1).Cumulative mortality and recovery of limb function was assessed in the first 136 patients with carotid distribution events. Admission blood glucose greater than or equal to 8 mmol/l was shown to be associated with a significantly greater mortality at 4 and 12 weeks (P less than 0.05). Multivariate analysis with age, glucose, HbA1 as independent variables demonstrated that age was the only significant predictor for death at 4 weeks (P less than 0.05) but at 12 weeks both age and blood glucose were significant (P less than 0.05). In patients less than 65 years blood glucose was a significant predictor for death (P less than 0.05) but in patients less than or equal to 65 years HbA1 and not glucose was significantly (P less than 0.05). Patients greater than or equal to 65 years with HbA1 greater than or equal to 7.5% were significantly more likely to have a raised admission blood glucose. Hyperglycaemia on admission was not shown to influence recovery of limb function.Increasing age is of greatest importance in predicting mortality although blood glucose is of prognostic value especially in the young stroke patient.
Basosquamous carcinoma, a wolf in sheep’s clothing? Report of 3 cases
Authors: Johnson B F , Moore P J , Goepel J R , Slater D N 
Published: December 2008

Summary
Basosquamous carcinoma of the skin is a lesion with specific histological features and recognized metastatic potential. Three cases of metastatic basosquamous carcinoma are reported, two of which were rapidly fatal. They illustrate that diagnostic features may be absent in a small biopsy and that metastasis is usually associated with a poor prognosis.
Mondor’s disease associated with metastatic lung cancer in the breast
Authors: Courtney S P , Polacarz S , Raftery A T 
Published: December 2008

Summary
We report what we believe is the first recorded case of Mondor’s disease associated with metastatic lung cancer presenting in the breast. An association between Mondor’s disease and primary breast cancer has been described previously. In patients with Mondor’s disease and primary breast cancer has been described previously. In patients with Mondor’s disease the possibility of underlying carcinoma, either primary or secondary, must be considered.
Red cell folate concentrations in patients with Crohn’s disease on parenteral nutrition
Authors: Tominaga M , Iida M , Aoyagi K , Kohrogi N , Matsui T , Fujishima M 
Published: December 2008

Summary
To examine changes in the folate concentrations in red cell during relatively long-term total parenteral nutrition (TPN), 10 Japanese patients with Crohn’s disease (7 males), the mean Crohn’s disease activity index on admission being 211, were given folic acid in a dose of 400 micrograms/day (AMA-FDA formulation) or 800 micrograms/day for 6-16 weeks (mean 10.5). The red cell folate concentrations were determined before TPN and once every week or 2-4 weeks thereafter. The folate concentrations were very low even after TPN with folic acid of 400 micrograms/day. In those given 800 micrograms of daily folic acid, the folate levels tended to increase, but did not reach the normal range. We propose that folic acid over 800 micrograms/day or a double dose of AMA-FDA formulation should be prescribed for Crohn’s disease treated with long-term TPN.