bluuebunny/crossref_metadata_2025_split huggingface dataset:
Staphylococcal enterotoxins in scarlet fever complicating chickenpox
Authors: Brook M G , Bannister B A 
Published: December 2008

Summary
Two cases of scarlet fever are described, both following super-infection of chickenpox. Enterotoxin B and C producing staphylococci were the only pathogens identified. The role of staphylococcal and streptococcal toxins in the pathogenesis of scarlet fever and toxic shock syndrome is discussed.
Clubbing associated with oesophageal adenocarcinoma
Authors: Polkey M I , Cook G R J , Thomson A D , Taylor N F 
Published: December 2008

Summary
A patient with an oesophageal adenocarcinoma, recent onset of digital clubbing, and evidence of increased oestrogen synthesis is presented. In the discussion, some of the theories of the pathogenesis of clubbing are reviewed, together with previous reports of clubbing in gastro-oesophageal disorders. A possible unifying theory is proposed for our case which we believe is the first report of this triple association.
Accidental golf club injuries
Authors: Pennycook A G , Morrison W G , Ritchie D A W 
Published: December 2008

Summary
Over a 2 month period, 33 patients with injuries caused by golf clubs were identified among attenders at the accident and emergency department at Glasgow Royal Infirmary. The vast majority of these were to the face and head, including three compound skull fractures. Attention is drawn to the average age of those injured (8.1 years) and to the fact that only one of the injuries occurred on a golf course. The dangers of unsupervised experimentation with golf clubs by young children are emphasized.
Mania in association with hydrocortisone replacement for Addison's disease
Authors: Ur E , Turner T H , Goodwin T J , Grossman A , Besser G M 
Published: December 2008

Summary
A 32 year old woman with untreated primary adenocortical insufficiency presented with prominent depressive symptoms. Upon treatment with physiological doses of glucocorticoids she developed a self-limiting acute manic illness. We suggest that up-regulation of hippocampal glucocorticoid receptors as a consequence of prolonged hypocortisolaemia resulted in increased cerebral sensitivity to exogenous corticosteroids, which are known to precipitate manic symptoms in some normal individuals when given in supraphysiological doses.
Post-infectious encephalomyelitis associated with Mycoplasma pneumoniae and Legionella pneumophila infection
Authors: Easterbrook Philippa J , Smyth Edward G 
Published: December 2008

Summary
A case of severe acute encephalomyelitis associated with a serological diagnosis of both Mycoplasma pneumoniae and Legionella pneumophila infection is reported. Serological co-positivity between these two pathogens has been reported previously, and has, in general, been attributed to cross-reactivity. This is the first documented case of co-infection using more sensitive and specific serological techniques. The potential significance of these findings is discussed in the context of the considerable problems in the interpretation of serological data.
Osteomalacia should be sought and treated before withdrawal of anticonvulsant therapy in UK Asians
Authors: Macallan D C , Maxwell J D , Eastwood J B 
Published: December 2008

Summary
Individuals from the Asian sub-continent in the United Kingdom are at particular risk of developing osteomalacia. We report a Gujarati woman who developed osteomalacia whilst taking anticonvulsant drugs; withdrawal of anticonvulsant therapy was followed by a seizure complicated by femoral neck fracture.
In patients with other risk factors for osteomalacia, as is the case for Asians living in Britain, anticonvulsant drugs should not be reduced or withdrawn until osteomalacia, which puts the skeleton at increased risk of fracture, and its associated hypocalcaemia, which reduces seizure threshold, have been sought and adequately treated.
Difficulties in localization and treatment of insulinomas in type 1 multiple endocrine adenomatosis (MEA)
Authors: Winocour Peter H , Moriarty Kieran J , Hales C Nicholas , Adams Judy , Reeve Roy , Wynick David , Allison David , Bloom Steven R , Anderson David C 
Published: December 2008

Summary
A 15 year old girl with a family history of type 1 multiple endocrine adenomatosis presented with reversible neurological disturbances, hypoglycaemia and hyperinsulinaemia. Initial radiology was normal, but portal venous sampling suggested an insulinoma in the tail of the pancreas which was removed with conservation of the spleen. Hypoglycaemia persisted despite high doses of diazoxide and intravenous dextrose. A second laparotomy revealed a pancreatic endocrine tumour and sub-total pancreatectomy was performed. Histology revealed islet cell microadenomatosis. Hypoglycaemia persisted despite treatment with somatostatin analogues and 40% intravenous dextrose was required to maintain normoglycaemia. A possible lesion near the splenic hilum on computed tomographic scan was reported as a splenunculus although further peripheral, hepatic and portal venous sampling suggested hepatic or systemic lesions. A positron emission scan and selective visceral angiography suggested a lesion in the left upper quadrant. Acute lactic acidosis, rhabdomyolysis and renal failure supervened. Post mortem revealed the putative 'splenunculus' to be a residual insulinoma, whilst the splenic vein was thrombosed, accounting in part for discrepant venous sampling data.
Hyperinsulinaemia in type 1 multiple endocrine adenomatosis may require more aggressive surgical and hormonal intervention than when dealing with solitary insulinomas. Insulinomas may mimic developmental abnormalities on computed tomographic scanning.
Systemic calciphylaxis presenting as a painful, proximal myopathy
Authors: Edelstein C L , Wickham M K , Kirby P A 
Published: December 2008

Summary
A renal transplant patient who presented with a painful, proximal myopathy due to systemic calciphylaxis is described. The myopathy preceded the characteristic skin and soft tissue necrosis. Systemic calciphylaxis should be considered in a dialysis or a renal transplant patient presenting with a painful proximal myopathy even in the absence of necrotic skin lesions.
Adult-onset mitochondrial myopathy
Authors: Fernandez-Sola J , Casademont J , Grau J M , Graus F , Cardellach F , Pedrol E , Urbano-Marquez A 
Published: December 2008

Summary
Mitochondrial diseases are polymorphic entities which may affect many organs and systems. Skeletal muscle involvement is frequent in the context of systemic mitochondrial disease, but adult-onset pure mitochondrial myopathy appears to be rare.
We report 3 patients with progressive skeletal mitochondrial myopathy starting in adult age. In all cases, the proximal myopathy was the only clinical feature. Mitochondrial pathology was confirmed by evidence of ragged-red fibres in muscle histochemistry, an abnormal mitochondrial morphology in electron microscopy and by exclusion of other underlying diseases. No deletions of mitochondrial DNA were found.
We emphasize the need to look for a mitochondrial disorder in some non-specific myopathies starting in adult life.
Sotalol-induced torsade de pointes: management with magnesium infusion
Authors: Arstall Margaret A , Hii John T Y , Lehman Ronald G , Horowitz John D 
Published: December 2008

Summary
A 69 year old woman was treated with sotalol (320 mg daily) for intermittent atrial fibrillation. Sotalol was initially well tolerated and reversion to sinus rhythm with sinus bradycardia occurred 4 weeks after initiation of therapy. Shortly thereafter, the patient developed recurrent syncope due to torsade de pointes. This was treated successfully with intravenous magnesium infusion and withdrawal of sotalol. Subsequently, the atrial fibrillation was adequately managed using amiodarone, with no recurrence of torsade de pointes. Development of bradycardia associated with reversion to sinus rhythm represents a potential cause of 'late' pro-arrhythmic effects of sotalol.
Extended transduodenal sphincteroplasty for bile duct stones associated with a periampullary diverticulum
Authors: Akoglu Musa , Sahin Burhan , Davidson Brian R 
Published: December 2008

Summary
Extended transduodenal sphincteroplasty has been suggested as an alternative to choledochoduodenostomy for the surgical management of bile duct stones associated with a periampullary diverticulum but its value has not previously been investigated. Over a 3 year period, nine patients underwent extended transduodenal sphincteroplasty for common bile duct calculi associated with a periampullary diverticulum with no operative or post-operative mortality and minimal morbidity. Follow-up ranging from 20 to 60 months has shown remission of pain in all but one patient, who has had a normal endoscopic cholangiogram and no further episodes of jaundice or cholangitis. Extended transduodenal sphincteroplasty is a safe and effective alternative to choledochoduodenostomy for the surgical management of choledocholithiasis associated with a periampullary diverticulum.
Blastomycosis-like pyoderma in a case of chronic myeloid leukaemia
Authors: Dutta Tarun K , James Joseph , Baruah M C , Ratnakar C 
Published: December 2008

Summary
Blastomycosis-like pyoderma, a rare skin lesion which may clinically resemble true blastomycosis, is seen in immuno-compromised individuals. We report one such case in chronic myeloid leukaemia.
Lipid and lipoprotein metabolism in familial combined hyperlipidaemia during treatment of sporadic phaeochromocytoma: a case study
Authors: Winocour Peter H , Masud Tahir , Clark Frederick , Cooper Brendan G , Laker Michael F , Alberti K George M M 
Published: December 2008

SummaryLipid metabolism was evaluated during management of phaeochromocytoma in a 41 year old non-obese post-menopausal women with familial combined hyperlipidaemia. The main effect of the excess catecholamine secretion on lipid metabolism was increased lipolytic activity, lower serum triglyceride and increased HDL cholesterol concentrations, compared with findings following removal of the tumour. Before removal of the tumour, the use of beta blockers alone led to marked deterioration of the hyperlipidaemic state, and combined α and beta blockade additionally led to a marked reduction in fat oxidation and lipoprotein lipase activity. Overactivity of the adrenergic system leads to changes in lipid metabolism in phaeochromocytoma. Treatment of the phaeochromocytoma may lead to worsening of hyperlipidaemia pre-existing in such individuals.
Systemic lupus erythematosus in 50 year olds
Authors: Domenech I. , Aydintug O. , Cervera R. , Khamashta M. , Jedryka-Goral A. , Vianna J. L. , Hughes G. R. 
Published: December 2008

Summary
We compared the clinical and serological characteristics of 15 patients with onset of systemic lupus erythematosus after the age of 50 with those of 232 younger patients. The sex distribution was similar in both groups. All 15 patients were Caucasian. Autoimmune thyroiditis was found in 20% of the elderly patients. Initial manifestations, which presented more frequently in the older group, included thrombocytopenia (P &lt; 0.05), sicca syndrome (P &lt; 0.01) and cardiomyopathy (P &lt; 0.005), whereas butterfly rash (P &lt; 0.05) presented more frequently in the younger group. Analysis of cumulative clinical symptoms showed that butterfly rash (P &lt; 0.05) and livedo reticularis (P &lt; 0.05) were less frequent in the elderly. However, this group presented a significantly increased incidence of sicca syndrome (P &lt; 0.005) and cardiomyopathy (P &lt; 0.005). Antibodies to double-stranded DNA tended to occur less frequently in older patients (P &lt; 0.05).
Intussusception in the adult: clinical, radiological and histological features
Authors: Courtney Stephen P. , Ibrahim Nassif , Longstaff Andrew J. , Davidson Colin M. 
Published: December 2008

Summary
Intussusception in the adult is an unusual cause of bowel obstruction. Unlike in childhood the clinical presentation is not clear cut and there are no distinct pathognomonic features. The radiological features are variable. Five patients presented to Frenchay Hospital over a five month period. The patients' clinical courses demonstrate the differing presenting features. Ultrasound investigation and CT scanning may show characteristic signs. Surgical treatment is mandatory as there is nearly always an underlying pathological abnormality which may be malignant.
Influence of cigarette smoking on the outcome of coronary care unit admissions with chest pain
Authors: Mallya S , Calverley P M A , MacFarlane I A , Hughes S , Johnston G , van Heyningen C 
Published: December 2008

Summary
We studied the effect of current smoking habits in the period immediately before admission to hospital in 90 consecutive patients presenting with chest pain, 50 of whom were shown to have myocardial infarction. Urine cotinine/creatinine (cot/creat) ratio measured within 4 hours of admission was used as an objective marker of cigarette smoking in the preceding 18 hours. Fifty-seven patients had urine cot/creat ratios suggesting recent smoking, although four of these denied smoking. Patients with myocardial infarction had higher median cot/creat ratios (3.31 micrograms/mg, range 0-17.8) compared with patients with non-infarct chest pain (0.5 microgram/mg, range 0-37.2). Sixteen patients with cardiac rhythm disturbances following infarction had significantly higher cot/creat ratios than the 34 infarct patients without this complication (median and range 8.34 micrograms/mg; 0-17.8 V. 1.87 micrograms/mg; 0-16.4, P &lt; 0.01). Tobacco use in the 24 hours before myocardial infarction may predispose to cardiac rhythm disturbance, irrespective of infarct size.
Costovertebral joint dysfunction: another misdiagnosed cause of atypical chest pain
Authors: Arroyo J F , Jolliet Ph , Junod A F 
Published: December 2008

Summary
The diagnostic work-up of atypical chest pain frequently leads to invasive procedures. However, this painful symptomatology can sometimes be of benign origin and respond to simple therapeutic manoeuvres. A number of musculoskeletal conditions such as costovertebral joint dysfunctions should be carefully considered. We report five cases in which patient discomfort and high costs could have been avoided if awareness of these conditions had led to a correct diagnosis upon initial physical examination.
Malignant fibrous histiocytoma of the pulmonary vein with prolapse through the mitral valve orifice
Authors: Khan Miqdad Ali , Davidson Robert C 
Published: December 2008

Summary
We present the case of a 33 year old white woman with malignant fibrous histiocytoma arising from the pulmonary vein and prolapsing through the mitral valve, causing acute heart failure. The patient underwent emergency cardiothoracic surgery with resection of the tumour while on cardiopulmonary bypass. The patient's heart failure improved immediately following the resection, demonstrating the benefit of palliative surgery. Adjuvant chemotherapy was recommended and the patient did well for 18 months of follow-up.
Primary renal renin secretion responding to angiotensin converting enzyme inhibition
Authors: Newrick P G , Millar N , Penney M , Corrall R J M 
Published: December 2008

Summary
A case of primary renal renin secretion of probable neoplastic origin is reported. Investigation demonstrated renin secretion to be incompletely autonomous with suboptimal suppression to posture and hypervolaemia. Easy control of the hypertension and hypokalaemia was achieved with an angiotensin converting enzyme inhibitor. Such treatment may prove to be a preferable option to surgery.
Safety of anticoagulation in the elderly: reasons for discontinuing therapy
Authors: O'Neill P A , Crossley D , Taberner D A , Fairweather D S 
Published: December 2008

Summary
We have conducted a retrospective study on the reasons for discontinuing anticoagulants in 50 patients over the age of 75 years compared with 198 adults under 75 years to determine the safety of therapy in the elderly. Venous thromboembolism and arterial embolization were the most common indications for therapy in the elderly and the median duration of therapy in all patients was 7 months (9 days-22 years). There were no deaths attributable to anticoagulants. There was no significant difference in the proportion of elderly patients who stopped treatment because of bleeding compared with 198 patients under 75 years (5/50 (10%) vs 12/198 (6.1%), P = 0.26), nor in the rate of bleeding between the two groups (5/52.5 (9.5%) treatment-years vs 12/249 (4.8%) treatment-years, P = 0.15). This complication rate does not suggest that age per se is a risk factor in the use of oral anticoagulants.
Biliary peritonitis secondary to perforation of common bile duct: an unusual presentation of chronic calcific pancreatitis
Authors: Kumar Arvind , Kataria R , Chattopadhyay T K , Karak P K , Tandon R K 
Published: December 2008

Summary
Common bile duct perforation causing biliary peritonitis is an unusual entity and a pancreatic calculus causing this perforation is all the more rare, and to our knowledge has not been reported previously. Such an unusual presentation of chronic calcific pancreatitis is herein reported.
The role of rigid oesophagoscopy in oesophageal carcinoma
Authors: Ritchie A J , McManus K , McGuigan J , Stevenson H M , Gibbons J R P 
Published: December 2008

Summary
The efficacy and safety of rigid oesophagoscopy in diagnostic and therapeutic settings in a consecutive series of 404 patients with oesophageal carcinoma were studied and compared to that for flexible oesophagoscopy in the same group. In addition, we examined the same parameters in a smaller group who had undergone radiotherapy with subsequent malignant stricturing. We performed 328 rigid procedures and 118 flexible procedures in a single regional surgical referral unit over a 7 year period. The combined perforation rate was 1.3%, with an overall mortality of 1% from 446 procedures.
We conclude that rigid oesophagoscopy in the presence of carcinoma retains an important diagnostic and therapeutic role which can be achieved with low incidence of perforation in high-risk patients.
Streptococcus bovis endocarditis as a presenting manifestation of idiopathic ulcerative colitis
Authors: Moshkowitz M , Arber N , Wajsman R , Baratz M , Gilat T 
Published: December 2008

Summary
Streptococcus bovis bacteraemia and endocarditis have been associated with several gastrointestinal diseases, mainly malignant or potentially malignant tumours, and less commonly non-malignant gastrointestinal disorders. We describe a 73 year old man in whom Streptococcus bovis endocarditis developed, and was the presenting manifestation of undiagnosed quiescent ulcerative colitis. Such an association has not been described previously.
Cigarette smoking and Helicobacter pylori infection
Authors: Bateson Malcolm C 
Published: December 2008

Summary
The direct urease test was used in 462 patients with normal upper digestive tracts, 108 with duodenal ulcers and 43 with gastric ulcers who attended for upper digestive endoscopy in a prospective study. There was a strong association between Helicobacter pylori infection and current cigarette smoking in patients with normal endoscopy (49.6% vs 35.5%, P &lt; 0.01). The associations of peptic ulcer both with H. pylori infection and cigarette smoking were also confirmed.
The excess of peptic ulcer disease in cigarette smokers may be explained by their increased susceptibility to H. pylori infection.
Acute mesenteric ischaemia: the continuing difficulty in early diagnosis
Authors: Heys Steven D , Brittenden Julie , Crofts Trevor J 
Published: December 2008

Summary
Five cases of acute intestinal ischaemia due to occlusion of the superior mesenteric artery, all with a delay in diagnosis, are reported here. These cases illustrate the continuing difficulties, in clinical practice, in recognizing mesenteric ischaemia before intestinal infarction has occurred, despite the clinical awareness of this condition.
Intestinal infarction following carbon monoxide poisoning
Authors: Balzan M , Cacciottolo J M , Casha A 
Published: December 2008

Summary
A 65 year old patient admitted with carbon monoxide poisoning developed acute pulmonary oedema during treatment with hyperbaric oxygen. After initial recovery he developed extensive intestinal ischaemia which rapidly led to death. It is suggested that intestinal vasoconstriction due to left ventricular failure made the gut much more vulnerable to the hypoxic effects of carbon monoxide than the brain and heart.
Combined transhepatic and endoscopic procedures in the biliary system
Authors: Verstandig Anthony G , Goldin Eran , Sasson Talia , Weinberger Gerald , Wengrower Dov , Fich Alex , Lax Emeric 
Published: December 2008

Summary
Endoscopic biliary procedures are 89-97% successful in skilled hands. The commonest causes of failure are inability to cannulate the papilla of Vater due to difficult anatomy or tortuosity of the distal common bile duct and failure to cross a rigid biliary stricture. In nearly all of these cases, successful endoscopic procedures can be completed after percutaneous antegrade placement of a small catheter or guidewire to the duodenum. In 44 such combined procedures on 42 patients, the success rate was 43 (98%). There were two severe and eight mild complications. Combined procedures overcome the difficulties caused by tortuous biliary ducts and rigid strictures while obviating the need for more extensive percutaneous procedures and transhepatic tract dilatation.
Multiple lymphomatous polyposis and the role of fine needle aspiration cytology
Authors: Carder P J , Gouldesbrough D R 
Published: December 2008

Summary
Multiple lymphomatous polyposis is an uncommon but distinctive form of gastrointestinal lymphoma. Clinical symptoms may closely resemble those of colorectal carcinoma and diagnostic confusion may result. The condition has a characteristic pathological appearance and immunophenotype which is important in allowing distinction from other less aggressive forms of gastrointestinal lymphoma. We report a case of this unusual condition in which the diagnosis was aided by fine needle aspiration cytology.
Microvascular investigations in diabetes mellitus
Authors: Chittenden Sandra J , Shami Shukri K 
Published: December 2008

SummaryThis paper reviews the current literature concerning the different investigative modalities available to assess the microcirculation in diabetic microangiopathy. The advantages and disadvantages of the different invasive and noninvasive methods available are presented objectively. We have concentrated on the tests that provide a quantitative assessment of the microcirculation, including laser Doppler fluxmetry, capillary microscopy, plethysmography, transcutaneous oximetry and radioactive isotope clearance. Some of the invasive methods described are now being replaced by noninvasive equivalents, providing similar information with less discomfort and risk to the patient.
Shigella bacteraemia in adults
Authors: Trevett A J , Ogunbanjo B O , Naraqi S , Igo J D 
Published: December 2008

SummaryShigella infections are usually restricted to the intestine. There are few reports of Shigella isolated from the blood and most of these are from children, usually in neonates and the malnourished. In the small number of adult cases of Shigella bacteraemia which have been reported, there appears to be an association with underlying disease and immunosuppression including acquired immunodeficiency syndrome.We report three adult cases in which Shigella were isolated from blood. Two of these patients made an uneventful recovery whilst the third died. An underlying cause of immunosuppression was suspected in this patient but unproven.