bluuebunny/crossref_metadata_2025_split huggingface dataset:
Secundum atrial septal defect repair: long-term surgical outcome and the problem of late mitral regurgitation
Authors: Speechly-Dick M E , John R , Pugsley W B , Sturridge M F , Swanton R H 
Published: December 2008

Summary
This study examines the clinical and surgical outcome of a group of 55 patients (mean age 33 years) with secundum atrial septal defect who underwent surgical repair of this defect between 1981 and 1990. A group of 25 of these patients underwent late echocardiographic follow-up.
Fifty-two patients underwent repair by direct suturing and three by patch closure. Surgical mortality was nil. There was one late death of a 58 year old who died from cardiac failure 4 years after surgery. Late postoperative morbidity consisted of two patients; one, age 63 at the time of surgery, required mitral and tricuspid valve replacement 6 years later and one, age 77 at surgery, developed cardiac failure 3 years later. Atrial fibrillation persisted in the six patients who had the rhythm before surgery and developed postoperatively in two patients aged 54 and 58. Two patients aged 49 and 57 developed immediate postoperative sinus node dysfunction requiring permanent pacing. The mean age at surgery of those six patients who suffered cardiac morbidity was 60 years. The patients with preoperative angiographic evidence of mitral valve prolapse were significantly older (P &lt; 0.001) and had higher mean pulmonary artery pressures (P &lt; 0.001) than patients with normal valves. There was no significant relationship between shunt size and mitral valve prolapse.
Echocardiographic follow-up showed persistent mitral valve prolapse in all nine patients who developed the condition preoperatively. Five patients developed mitral valve prolapse with mitral regurgitation postoperatively, one of whom needed subsequent mitral and tricuspid valve replacement. These five patient were on average older (mean age 54) but the group was too small to prove significance.
The follow-up data illustrate the current low mortality and morbidity associated with surgical closure of atrial septal defects. Late postoperative echocardiography had revealed not only that mitral valve prolapse persists in those patients who developed the condition pre-operatively but that new cases of mitral valve prolapse with mitral regurgitation can occur after atrial septal defect closure.
Successful treatment of Pseudomonas paucimobilis haemodialysis catheter-related sepsis without catheter removal
Authors: Saltissi David , Macfarlane David J 
Published: December 2008

Summary
Infection is the most common complication of long-term central venous access lines. We report a case of central venous haemodialysis catheter infection with Pseudomonas paucimobilis, successfully treated by prolonged antibiotic administration without catheter removal. The implications are discussed.
Bone density in osteogenesis imperfecta may well be normal
Authors: Paterson Colin R , Mole Patricia A 
Published: December 2008

Summary
Osteogenesis imperfecta (OI) is often regarded as a form of osteoporosis. However, the bone fragility is the result of defective collagen and earlier work has demonstrated that cortical thickness, in bones not previously fractured, is usually normal. We have now measured the bone mineral content of the distal forearm in 61 adult patients with well characterized OI.
Three patients with the Silence type III disorder had bone mass values well below the reference interval. For the 47 type I patients and 11 type IV patients, the bone mass was significantly lower than normal (P &lt; 0.001). However 70% of patients had values within the reference interval. One cannot therefore exclude the diagnosis of OI by finding normal values with densitometry.
Diagnostic difficulties do not occur in type III patients and our main objective was to recruit as many individuals as possible with OI types I and IV. In the type IV disease, the diagnosis can be particularly difficult without a positive family history. Since the evaluation of bone density by subjective examination of radiographs is a much less precise procedure, most patients with type I and IV OI would be expected to have 'normal' appearances with this assessment. Osteogenesis imperfecta cannot be excluded on the basis of apparently normal bone density or cortical thickness with routine radiographs.
Leprosy presenting as unilateral foot drop in an immigrant boy
Authors: Choe Wonsick 
Published: December 2008

SummaryThis is a case report of a boy who presented with unilateral foot drop approximately 1 year after traumatic injury from skateboarding. Exploratory surgical operation was eventually performed, and histological examination of the surgical specimen revealed leprous peripheral neuropathy of the peroneal nerve. The patient had immigrated from Vietnam to the United States 3 years previously. The occurrence, albeit rare, of this entity in the immigrants from endemic leprosy regions is discussed.
Indian herbal remedies for diabetes as a cause of lead poisoning
Authors: Keen R W , Deacon A C , Delves H T , Moreton J A , Frost P G 
Published: December 2008

Summary
Herbal remedies from the Indian subcontinent have been found to have high concentrations of heavy metals and unsupervised treatment may result in toxicity. We report the case of an Indian patient with hepatitis who was found to have lead poisoning where the source was traced to ethnic remedies he had been taking for diabetes.
The Jarisch-Herxheimer reaction in leptospirosis
Authors: Vaughan Carl , Cronin Cornelius C , Walsh Elizabeth Kenny , Whelton Michael 
Published: December 2008

Summary
Three patients with leptospirosis whose condition worsened after initiation of antibiotic therapy are reported. Their clinical deterioration appeared to be due to the development of the Jarisch-Herxheimer reaction rather than to progression of their underlying infection. Relevant aspects of the management of patients with leptospirosis are discussed.
Small bowel obstruction due to encapsulation and abnormal artery
Authors: Adedeji O A , McAdam W A F 
Published: December 2008

Summary
A case of peritoneal encapsulation is reported. Of fourteen reported and two anecdotal cases, this is the third case with small bowel obstruction. Bowel malrotation is associated with the condition and in our case an abnormal artery was the cause of obstruction. We support previous authors' suggestions that, if the condition is found incidentally at laparatomy, it should be treated surgically by excision of the peritoneal sac and division of any tight band.
Prevalence of dyspepsia: the epidemiology of overlapping symptoms
Authors: Grainger S L , Klass H J , Rake M O , Williams J G 
Published: December 2008

SummaryStudies of the epidemiology of dyspepsia have been complicated by the use of different symptom definitions, subject populations and time frames of investigation. Published figures for the prevalence of dyspepsia vary from 20% to 40%, of which perhaps only a quarter can be attributed to peptic ulcer disease. General practitioners see only a fraction of the dyspepsia within the community, the majority of which is either ignored or treated by self-medication. However, dyspepsia still accounts for about 3-4% of all general practice consultations and for about 14% of all patients attending. In about half of all cases, even extensive investigation reveals no underlying organic lesion.There has been much recent interest in the clinical value of grouping dyspeptic symptoms into particular subtypes. These have been called ulcer-like, dysmotility-like and reflux-like. Although these patterns have descriptive value, there is no evidence that they result from discrete pathophysiological processes. Indeed, studies both in general practice and in the community show a large degree of overlap between them.
Serious unexpected sinus infection discovered by CT scanning for presumed neurological disease
Authors: Swift Andrew C , Gill Geoffrey V 
Published: December 2008

SummarySerious infection in the paranasal sinuses may present with symptoms suggestive of neurological disease and thus lead to delay in the diagnosis and subsequent treatment. We present three such cases in whom the initial diagnoses had been acute optic neuritis, a posterior communicating aneurysm and an intracranial space occupying lesion. The fourth patient had meningitis but the paranasal sinuses had not initially been considered as a possible source of infection. The current methods of diagnosing sinusitis are discussed.
The timing of breast cancer surgery within the menstrual cycle
Authors: Corder A P , Cross M , Julious S A , Mullee M A , Taylor I 
Published: December 2008

Summary
The effects of the timing of surgery, fine needle aspiration cytology (FNAC) and mammography within the menstrual cycle were investigated retrospectively in 211 premenopausal breast cancer patients. The day of surgery within the menstrual cycle was known for 157 women whose menstrual cycles were regular. Recurrence and survival were closely similar whether surgery was performed during days 3-12 or at other times (days 0-2 or 13-32) in the cycle. Outcome was also unrelated to the timing of mammography which was known in 101 cases. There were no significant differences in recurrence or survival associated with the timing of FNAC when all patients were considered.
In the subset of lymph node negative patients (n = 32), however, FNAC outside days 3-12 was associated with a significantly decreased rate of relapse (RR = 0.25, 95% CI = 0.07-0.9) and death (RR = 0.10, 95% CI = 0.02-0.9). These patients, however, also had significantly smaller tumours (median = 2 cm, interquartile range = 2-3 cm) than patients having FNAC on days 3-12 of the cycle (median = 3, interquartile range = 2-4) (Mann-Whitney: z = 2.11, P = 0.04).
We have not confirmed that surgery or FNAC during days 3-12 of the cycle is associated with a poorer outcome than interventions during other parts of the cycle.
Splenectomy in patients with undiagnosed splenomegaly
Authors: Cronin C C , Brady M P , Murphy C , Kenny E , Whelton M J , Hardiman C 
Published: December 2008

Summary
Of splenectomies performed in the Cork Regional Hospital over an 11 year period, ten were undertaken primarily for diagnostic purposes. A definitive histological diagnosis was established in nine patients, seven of whom had lymphoma, two with Hodgkin's disease and five with non-Hodgkin's lymphoma. The weight of the excised spleen in all patients with lymphoma exceeded 1 kg; in all those with a diagnosis other than lymphoma, the spleen weighed less than 1 kg. A majority of patients also had symptomatic improvement from reversal of hypersplenism and from relief of the mechanical pressure effects of an enlarged spleen. Operative mortality was zero.
Diagnostic splenectomy is a worthwhile procedure. Most patients will have lymphoma.
Attitudes of junior medical staff to requesting permission for autopsy
Authors: Hinchliffe Stephen A , Godfrey Hugh W , Hind Charles R K 
Published: December 2008

Summary
The attitudes of junior medical staff in a university teaching hospital to requesting postmortem examination were assessed. Following completion of 100 death certificates, autopsy was sought in only 28 cases (and refused in 18). The majority of staff were unaware of the reported benefits of autopsy, despite their inclusion in the local medical handbook and had received no training in how to seek permission for a necropsy. Formal education programmes have been shown to improve hospital autopsy rates and the results of this study suggest that these would be welcomed by junior medical staff.
Use of ketorolac by continuous subcutaneous infusion for the control of cancer-related pain
Authors: Myers Kathryn G , Trotman Ivan F 
Published: December 2008

Summary
Ketorolac tromethamine is a newly available non-steroidal anti-inflammatory drug which is suitable for parenteral administration. We have given it by continuous subcutaneous infusion to 36 patients with pain due to advanced cancer. Improvement in pain control occurred in 29 (80%). A reduction in the dose of concomitant opioid analgesia was possible in 22 (76%) and a reduction in opioid-related adverse effects occurred in 16 (73%) of these. Ketorolac was most effective in patients who had bone or visceral pain. It was mixed safely with diamorphine in a syringe driver at concentrations up to 4 g diamorphine/10 ml and 120 mg ketorolac/10 ml. Infusion was well tolerated for periods of up to 115 days (mean 21 days; median 15 days; range 3-115 days). Four patients experienced gastrointestinal bleeding and one colonic perforation to which treatment with ketorolac may have been a contributory factor. No other clinically significant adverse effects were observed.
Anorexia nervosa and necrotizing colitis: case report and review of the literature
Authors: Sakka Samir , Hurst Paul , Khawaja Hamid 
Published: December 2008

Summary
A 20 year old woman with anorexia nervosa and severe weight loss developed extensive necrotizing colitis after being admitted to hospital for stabilization of her weight. Necrotizing colitis with anorexia nervosa has been reported previously. We report a second case. We believe necrotizing colitis is a true complication of anorexia nervosa and should be considered in the differential diagnosis in patients with primary anorexia who develop an acute abdomen.
T cell non-Hodgkin's lymphoma presenting in the first trimester of pregnancy
Authors: Lees C C , Tsirigotis M , Carr J V L , Richards M A 
Published: December 2008

Summary
This case report details of the presentation of a young woman in the first trimester of her pregnancy with lethargy, weakness, vomiting, pyrexia and lymphadenopathy. Extensive investigation revealed an advanced T cell lymphoma and only the second reported case in pregnancy to our knowledge. We discuss her management and subsequent chemotherapy in the context of a short review of the literature spanning the last decade.
Reversible digital clubbing in acute myeloid leukaemia
Authors: Bhandari S , Wodzinski M A , Reilly J T 
Published: December 2008

Summary
A 43 year old woman presented with acute myeloid leukaemia, marked finger and toe clubbing, and a hilar mass. Biopsy of the hilar mass was not technically possible, but it almost certainly represented a granulocytic sarcoma since chemotherapy induced rapid resolution of the mass along with reversal of the clubbing and remission of the leukaemia. Relapse of the leukaemia 21 months later was associated with return of the clubbing. It is hypothesized that an abnormal circulation within the granulocytic sarcoma may have accounted for the development of clubbing.
The features and aetiology of Fournier's gangrene
Authors: Efem S E E 
Published: December 2008

Summary
This paper reports a clinical study of 20 cases of gangrenous ulcers of the scrotum and/or of the penis (Fournier's gangrene) and a review of previous publications. Even though found mostly in elderly male patients, the disease spares no age group and can involve the external genitalia in neonates and women as well. The disease is a necrotising fasciitis of infective origin and always has a portal of entry of the infecting organisms even though it may be so trivial as to be undetected. The commonest portals of entry of infection are periurethral sepsis, groin wound sepsis, anorectal sepsis, prostatic sepsis and trauma. The infecting organisms comprise both aerobic and anaerobic organisms such as Escherichia coli, Streptococcus pyogenes, Pseudomonas aeruginosa, Klebsiella pneumonia, Proteus mirabilis, enterococci, Bacteroides fragilis and anaerobic streptococcus. Fournier's gangrene is probably the same disease as necrotizing fasciitis occurring in other parts of the body, but modified by the peculiar anatomy of the genitoperineum.
Clinical presentation of orthostatic hypotension in the elderly
Authors: Craig G M 
Published: December 2008

Summary
Fifty cases of orthostatic hypotension in the elderly are analysed. Three main modes of presentation were identified: (1) falls or mobility problems; (2) mental confusion or dementia; or (3) predominantly cardiac symptoms. Selected case histories are given to illustrate diagnostic difficulties. Medication was responsible for orthostatic hypotension in 66% of patients and striking examples of polypharmacy were encountered. However, 34% of cases were not iatrogenic. Only 14% of patients had overtly postural symptoms. A high index of suspicion is needed to diagnose orthostatic hypotension in the elderly and the condition is often overlooked. The paper provides useful diagnostic clues for clinicians.
Tumour lysis syndrome after treatment of chronic lymphocytic leukaemia with fludarabine
Authors: Montalban Carlos , Liaño Fernando , Aguilera Abelardo 
Published: December 2008

Summary
Fludarabine is one of the most recent and promising therapeutic agents for chronic lymphocytic leukaemia. We describe a patient who developed tumour lysis syndrome after the first course of treatment with fludarabine and call attention to this uncommon but potentially lethal complication that has not been previously taken into account in this neoplasia. It should always be anticipated when patients are treated with new and effective drugs.
Cytomegalovirus myocarditis following liver transplantation
Authors: Stack William A , Mulcahy Hugh E , Fenelon Lynda , Hegarty John E 
Published: December 2008

Summary
Cytomegalovirus (CMV) infections are commonly found in patients on immunosuppressive therapy following liver transplantation. However, acute myocarditis is an extremely rare manifestation of CMV infection in this setting. We report the case of a patient who developed acute myocarditis with severe biventricular failure with a cardiac ejection fraction of less than 10%, 6 weeks following orthotopic liver transplantation. Systemic CMV infection was diagnosed on the basis of a clinical viraemia, the presence of CMV antigen in urine, blood, and throat swab, and an associated four-fold rise in serum antibody titres to CMV. A full recovery ensued following treatment with standard anti-cardiac failure therapy and a 10 day course of intravenous ganciclovir.
Effect of acute cytomegalovirus infection on drug-induced SLE
Authors: Schattner Ami , Sthoeger Zeev , Geltner David 
Published: December 2008

Summary
A 58 year old woman developed systemic symptoms, interstitial lung disease, splenomegaly, leukopenia and anti-histone and anti-nuclear antibodies (ANA), while treated with hydralazine for hypertension. Five months after presentation she was admitted with high fever, skin rash and atypical lymphocytosis due to acute cytomegalovirus (CMV) infection. Worsening leukopenia and increased ANA were found, and high titres of anti-DNA antibodies, anti-cardiolipin antibodies and rheumatoid factors appeared. Hydralazine was stopped and the patient gradually became asymptomatic. All autoantibodies spontaneously disappeared (over 16 weeks), and the white cell count and spleen size became normal. The patient was found to be a slow acetylator and to have both HLA-DR4 and selective IgA deficiency.
Thus, a multifactorial genetic susceptibility to develop drug-induced lupus was brought out in stages first by hydralazine and then by CMV, yet all manifestations and autoantibodies resolved spontaneously, demonstrating the complex interplay of varied environmental factors with a genetic predisposition in the pathogenesis of autoimmunity.
Pseudohyperkalaemia associated with hereditary spherocytosis in four members of a family
Authors: Alani F S S , Dyer T , Hindle E , Newsome D A , Ormerod L P , Mahoney M P 
Published: December 2008

Summary
Pseudohyperkalaemia was detected in four members of a family all of whom have hereditary spherocytosis with normal white blood cells and platelets counts. The degree of pseudohyperkalaemia was related to the time between sampling and cell separation, and inversely related to the temperature in which the sample was left to stand before cell separation. A fifth member of this family was free from both conditions. The association suggests linkage at a membrane level.
45,X Turner syndrome with normal ovarial function and multiple malformations of the aorta
Authors: Apostolopoulos T D , Kyriakidis M K , Kitsiou S A , Galla-Voumvouraki A D , Tsezou A N , Toutouzas P K 
Published: December 2008

Summary
We present a case of a female patient with monosomy of X chromosome in peripheral lymphocytes and skin fibroblasts, normal ovarian function and associated multiple congenital abnormalities of the aorta: bicuspid aortic valve, dilatation of the ascending aorta and multiple cystic structures of the aortic wall, complicated by endarteritis. We review the literature on fertile women with 45,X karyotype and the possible pathogenetic mechanisms of the aortic defects described as 'cystic medial necrosis of the aorta'.
Osteomyelitis and infective endocarditis
Authors: Speechly-Dick M E , Swanton R H 
Published: December 2008

Summary
Osteomyelitis is thought to occur as a complication of infectious endocarditis in as many as 6% of cases of endocarditis. We describe this association in three patients. Osteomyelitis may be difficult to diagnose in patients with endocarditis because symptoms such as fever, bone pain and stiffness are common to both illnesses, therefore physicians need to have a high index of suspicion to avoid missing this important complication. We recommend that patients with endocarditis and persistent or localized musculoskeletal symptoms should be investigated to exclude osteomyelitis. Plain radiographs can be normal in 50% of cases of osteomyelitis in the early stages or show only minor abnormalities, but bone scans are highly sensitive. We suggest that a bone scan is performed if radiography is unhelpful, since a diagnosis of osteomyelitis can effectively be excluded if the bone scan is normal. We advocate close follow-up of these patients with prolonged antibiotic treatment consisting of at least 6 weeks of intravenous therapy, and 3 months or longer of oral therapy.
Unusual cause of orthopnoea: primary tracheal tumour mimicking left ventricular failure
Authors: Antonios Tarek F , Singer Donald R J , Millard F J C , Wilson Allan G , MacGregor Graham A 
Published: December 2008

SummaryAn 84 year old woman who was a heavy smoker presented with clinical features suggestive of acute exacerbation of chronic obstructive lung disease complicated by left ventricular failure. She responded poorly to treatment and then the finding of stridor, only when she was in the supine position, led to the diagnosis of a primary tracheal tumour, a rare but important cause of unexplained shortness of breath.
Influenza vaccination: do the aged reap the benefit?
Authors: Morgan R , King D , Turnbull C J 
Published: December 2008

Summary
An audit of 100 elderly in-patients with appropriate medical conditions revealed that 63% had not been vaccinated this winter. 74% would have accepted vaccination if offered. A general practitioner questionnaire found that 42% relied on elderly patients coming forward and requesting vaccination. Unfortunately, many elderly patients are still missing out on influenza vaccination.
Guillain-Barré syndrome following meningococcal meningitis
Authors: Puri V , Khalil A , Suri V 
Published: December 2008

SummaryA case of Guillain-Barré syndrome following meningococcal meningitis is reported. The diagnosis was made on clinical grounds and the results of electrophysiological studies. The patient recovered spontaneously. Guillain-Barré syndrome following meningococcal infection has not to our knowledge been reported previously.