bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bleeding oesophageal varices associated with anabolic steroid use in an athlete
Authors: Winwood P J , Robertson D A F , Wright R 
Published: December 2008

Summary
A 30 year old bodybuilder who had been taking anabolic steroids for 18 months presented with bleeding oesophageal varices. Serious liver disease secondary to anabolic steroids including peliosis hepatis, nodular hyperplasia and malignant change is well recognized. We report what is, to our knowledge, the first case of bleeding oesophageal varices associated with the use of anabolic steroids.
Spontaneous rupture of the spleen in Legionnaires' disease
Authors: Holmes A H , Ng V W , Fogarty P 
Published: December 2008

Summary
A case of Legionnaires' disease is described in a 63 year old man who presented with pneumonia and confusion. Eleven days after admission he became acutely hypotensive and attempts at resuscitation failed. Post-mortem examination revealed spontaneous splenic rupture and massive hepatocellular necrosis—an outcome that has not previously been associated with Legionnaires' disease.
Coarctation of the aorta associated with a sinus venosus atrial septal defect presenting with endocarditis in middle age
Authors: D'Costa D F , Davidson A R 
Published: December 2008

SummaryWe report the case of a 44 year old man who presented with an infective endocarditis and was found to have a coarctation of the aorta associated with a sinus venosus atrial septal defect and a small ventricular septal defect. The association of coarctation with a sinus venous atrial septal defect presenting with endocarditis in an adult is extremely rare.
Testicular teratoma and peripheral neurofibromatosis
Authors: Hilton D A , Muller S , Macpherson D S 
Published: December 2008

Summary
Peripheral neurofibromatosis (Von Recklinghausen's disease) has been previously reported in association with a number of tumours and recently with aqueductal stenosis. We report a case which had both aqueductal stenosis and a testicular teratoma, which has not previously been reported in this condition.
Acute gastroenteritis: the need to remember alternative diagnoses
Authors: Felton J M , Harries A D , Beeching N J , Rogerson S J , Nye F J 
Published: December 2008

Summary
Five hundred and ninety-four patients were consecutively admitted to an infectious disease unit over a 2-year period with a referral diagnosis of acute gastroenteritis or food poisoning. In 175 (29%) patients, gastrointestinal symptoms were associated with a condition other than gastrointestinal infection. Non-infective gastrointestinal disease was present in 90 patients, systemic infection in 50 and systemic disease in 35. Four illustrative case histories are presented to emphasize the need for a high index of suspicion if diseases such as malaria, septicaemia or appendicitis are not to be missed.
Ipratropium bromide: are patients treated with optimal therapy?
Authors: Millar A B , Bush A , Al-Hillawi H , Goldman J , Denison D M 
Published: December 2008

Summary
A double-blind crossover placebo controlled study was performed on 20 patients with stable chronic asthma, in order to obtain dose response data to ipratropium bromide (40, 80, 200 micrograms) given by metered dose inhaler. The use of the 200 micrograms dose gave a significantly greater peak effect and duration of action than the recommended standard therapeutic dose of 40 micrograms. There were marked individual variations in response to higher doses. Maximum response detected by spirometry occurred within 24 hours of inhalation, thus patients likely to gain clinical benefit are readily identified. The higher dose was well tolerated by most patients and may have clinical application in the treatment of patients who do not respond to the standard dose regime.
High peripheral and axial bone densities in a postmenopausal woman with untreated hypoparathyroidism
Authors: Orr-Walker B , Harris R , Holdaway I M , Foote G , Reid I R 
Published: December 2008

Summary
It has been reported that bone density is increased in patients with treated hypoparathyroidism, though it is unclear whether this increase is attributable to the condition itself or to its treatment. We have recently investigated a 70 year old woman with untreated hypoparathyroidism from the time of thyroid surgery at the age of 29 years. Bone mineral content of the non-dominant distal forearm was 3.7 standard deviations above the mean normal value found in 23 healthy volunteers of comparable menopausal age, and was also above the mean normal value found in premenopausal women. The vertebral mineral density of her lumbar spine (measured by quantitative computed tomography) was 3.0 standard deviations above the mean normal value. These findings suggest that high bone density is a feature of hypoparathyroidism per se and that postmenopausal bone loss may be significantly attenuated in this condition.
Systemic sclerosis and chronic lymphocytic leukaemia
Authors: Sidi Y , Fadilah R , Pinkhas J , Prokocimer M 
Published: December 2008

Summary
The association between the CREST (calcinosis, Raynaud phenomena, oesophageal hypomotility, sclerodactyly and telangiectasia, variant of systemic sclerosis and chronic lymphocytic leukaemia is described in three patients. The present description raises the possibility that the association of chronic lymphocytic leukaemia and systemic sclerosis is non-random.
Sickle cell trait and stroke in the young adult
Authors: Radhakrishnan K , Thacker A K , Maloo J C , El-Mangoush M A 
Published: December 2008

SummaryTwo young patients with sickle cell trait (AS haemaglobinopathy) and ischaemic stroke are reported. The stroke involved the internal carotid artery territory in one and the brainstem in the other. A review of the literature is presented to suggest that the association of sickle cell trait and cerebral infarction is more than coincidental. Haemoglobin electrophoresis should be undertaken routinely in young subjects with ischaemic stroke.
Horizontal transmission of hepatitis B virus amongst British 2nd World War soldiers in South-East Asia
Authors: Gill G V , Bell D R , Vandervelde E M 
Published: December 2008

SummaryInfection with hepatitis B virus (HBV) is much more common in tropical than in temperate countries. Visitors to the tropics are thus at risk from HBV, though the degree of risk, and the routes of infection involved are uncertain. We report serological markers of HBV in two groups of 2nd World War soldiers, who served in the Thai/Burma jungles. The groups comprised 100 ex-prisoners of the Japanese (POW), and 100 Burma Campaign Veterans (BCV). Surface antigen to HBV (HbsAg) was positive in 0% of POW and 2% of BCV (P = not significant). Surface antibody (anti-HBs) and core antibody (anti-HBc) were both positive in 40% POW and 13% BCV (P &lt; 0.001). Quoted UK prevalence rates for these markers are 0.1% for HBsAg, 1.5% for anti-HBs and 0.7% for anti-HBc. Both groups thus show very high rates of past HBV infection. For the POW there were many possible reasons, including contaminated surgical instruments and needles, blood transfusions, and multiple beatings with common weapons. None of these factors operated significantly for BCV. Malarial transmission was, however, intense in both groups, though more so in POW. The data thus again raise the possibility of horizontal transmission of HBV by biting insects in tropical countries.
Simultaneous occurrence of transient resolving thyrotoxicosis due to painless thyroiditis, hypopituitarism and diabetes insipidus following pituitary apoplexy
Authors: Sasaki Haruka , Ohnishi Osamu , Okudera Toshio , Okumura Makoto 
Published: December 2008

Summary
A rare case of concomitant association of transient thyrotoxicosis due to painless thyroiditis, hypopituitarism and central diabetes insipidus following spontaneous pituitary apoplexy is presented.
Cyclic oscillations of leucocyte counts in chronic myeloid leukaemia
Authors: Malhotra O P , Salam S R 
Published: December 2008

Summary
A patient with chronic myeloid leukaemia, having two unusual features, is described. He had absence of splenomegaly and marked periodic fluctuations of leucocyte counts, occurring spontaneously, in the initial phase of the disease. The latter finding suggests that, at least in some patients with chronic myeloid leukaemia, negative feed back control mechanism(s), possibly exerted by colony stimulating factor, may be retained which may have therapeutic implications.
Asymptomatic cerebral calcification—a previously unrecognized feature
Authors: Arnold M M , Kreel L 
Published: December 2008

Summary
While investigating the radiological appearances of globus pallidus calcification in an autopsy case, cortical-pia mater calcification was detected. There was no documentation of its existence in the literature of radiology, neurology and neuropathology. To establish its incidence and clinical significance, 20 consecutive autopsy brains (15 males, 5 females, age 32–73 years, mean age 56.7) were studied with high resolution radiography and histology. Clinical records, autopsy findings, in-life plain skull films and computed tomography of the brain (if available) were reviewed. Radiologically, the calcifications appeared as 1–2 mm irregular spots or tiny pin-point opacities in the pia mater and subcortical regions, either unilaterally or bilaterally in the frontal (15 cases), temporal (15), parietal (3) and occipital lobes (1). Similar calcification was detected in 1 of the 3 in-life computed tomographic scans available. Histologically, these cortical-pia mater calcifications were extracellular amorphous calcified masses of various sizes in necrotic neural tissue, frequently associated with microscopic haemorrhage and hypoxic neuronal changes in the adjacent brain tissue. Blood vessels in the region were not hyalinized or calcified. The occurrence was not related to age. Hospital stay was &lt; 7 days in 14 and &lt; 30 days in 2; 50% of patients died within 48 hours after admission. None of the patients had records of long term cytotoxic chemotherapy, radiotherapy or central nervous system infection. Two had stroke, one had cerebellar atrophy and one mild hypercalcaemia. The high incidence of calcifications in the temporal lobes, while asymptomatic, suggests that cortical calcification may be a pointer to the aetiology of idiopathic epilepsies in the elderly.
Exchange transfusion of a patient with fulminant Lassa fever
Authors: Cummins D , Bennett D , Machin S J 
Published: December 2008

Summary
We report a patient with fulminant Lassa fever who responded dramatically to a 2.5-litre exchange transfusion of whole blood. On admission he was semicomatose with facial oedema and oral haemorrhage; his platelets showed markedly depressed aggregation to ADP; and his plasma inhibited the aggregation responses of normal platelets in vitro. Exchange transfusion resulted in rapid clinical improvement, recovery of platelet function, and disappearance of platelet-inhibitory activity in plasma. The patient died 2 weeks later from an acute encephalopathy. His initial response was sufficiently impressive to suggest that further evaluation of this therapeutic approach is justified in selected patients with overwhelming Lassa virus infection.
Bilateral papillitis with anti-neutrophil cytoplasmic antibodies associated with coeliac disease
Authors: Chan-Lam D , Balasubramanian V , Hogg R B 
Published: December 2008

Summary
A 39 year old woman with untreated coeliac disease presented with some of its complications and bilateral papillitis. She was found to have antineutrophil cytoplasmic antibodies (ANCA) in high titres. Following institution of gluten-free diet the complications resolved. The papillitis, however, persisted and needed a course of prednisolone to resolve, and a fall in the ANCA titres was noted. We believe that this is the first report of an association of coeliac disease and ANCA.
Intraocular pressure and pupillary responses in patients with diabetes mellitus
Authors: al-Sereiti M R , Turner P , Gale E A M 
Published: December 2008

Summary
Intraocular pressure (IOP) and the mydriatic responses to darkness in 38 diabetic patients have been compared with those of a matched control group of normal subjects. Overall, the diabetic patients had a significantly higher mean IOP than the control group, but this difference was not found in a sub-group of 13 diabetic patients with evidence of autonomic neuropathy. Those diabetic patients with evidence of autonomic neuropathy had a smaller mydriatic response to darkness than the control group, and this test may usefully be added to standard tests of autonomic function in the diagnosis of autonomic neuropathy.
Stercoral perforation of the colon proximal to an end colostomy
Authors: Serpell J W , Sen M , Giddins G , Nicholls R J , Bradfield W J D 
Published: December 2008

Summary
Stercoral perforation of the colon is rare, and has not previously been reported as a postoperative complication, proximal to an end colostomy. Two such cases are reported; in addition in one the stercoral perforation was recurrent, emphasizing the multifocal nature of the disease. Both cases demonstrate the failure of standard techniques to deal with scybala in the loaded proximal colon. It is, therefore, suggested that intra-operative orthograde colonic lavage is indicated to protect a terminal colostomy from the risk of stercoral perforation in such cases.
Prolonged faecal excretion of poliovirus in a nurse with common variable hypogammaglobulinaemia
Authors: Misbah S A , Lawrence P A , Kurtz J B , Chapel H M 
Published: December 2008

Summary
A nurse with common variable hypogammaglobulinaemia was found to excrete a non-vaccine strain type II poliovirus for almost a year following a bout of gastroenteritis. Attempts were made to halt intestinal carriage of the virus in view of the possible risk of spread to immunocompromised patients and the risk of paralytic poliomyelitis to the patient himself.
Three doses of killed Salk vaccine failed to stimulate salivary anti-polio antibodies. Excretion of the virus ceased spontaneously just before oral immunoglobulin containing high titres of antibodies to polio virus was used to halt virus excretion.
Percutaneous endoscopic gastrostomy in elderly patients
Authors: Finucane P , Aslan S M , Duncan D 
Published: December 2008

Summary
Percutaneous endoscopic gastrostomy (PEG) was performed on 28 elderly patients (mean age 82 years) who were dysphagic and intolerant of naso-gastric feeding. Twenty-six patients were recovering from a stroke; the interval between the onset of stroke and PEG averaged 63 days. The procedure was successful and well tolerated by all patients. Nineteen (68%) still had a functioning PEG a median of 14 weeks after placement. One patient whose swallowing recovered had the tube removed 6 months after its insertion. Seven patients (25%) subsequently died from their underlying disease, a mean of 92 days following PEG. There was one procedure-related death from peritonitis. PEG is a useful alternative to surgical gastrostomy in selected elderly patients with dysphagia who are intolerant of naso-gastric feeding.
Misoprostol does not alter the pharmacokinetics of propranolol
Authors: Bennett P N , Fenn G C , Notarianni L J , Lee C E 
Published: December 2008

Summary
Twelve healthy volunteers took part in a randomised, double-blind, balanced, cross-over study to investigate the effect of misoprostol on the pharmacokinetics of propranolol. The subjects took propranolol 80 mg twice daily by mouth plus either misoprostol 400 micrograms twice daily or placebo by mouth for 14.5 days, followed by a 2-week washout period, followed by the alternate treatment for 14.5 days. Misoprostol had no significant effect on the t/2, Cmax or AUC of propranolol either after a single dose or at steady state.
Marfan syndrome affecting four generations of a family without ocular involvement
Authors: Bridges A B , Faed M , Boxer M , Haining W M , Pringle T H , McNeill G P 
Published: December 2008

Summary
Thirty eight relatives of a patient with Marfan syndrome were screened for the presence of this disorder. Marfan syndrome was newly diagnosed in living members of 4 generations in this family without evidence of ocular abnormality in any. After screening, 10 relatives were newly diagnosed as having definite, and 5 relatives as having possible, Marfan syndrome. Family screening has drawbacks as well as benefits for the patients. The main benefit is the identification and treatment of previously undiagnosed patients at risk of cardiac complications which are the major cause of mortality. The drawbacks include employment problems created for patients with Marfan syndrome as a direct consequence of our screening programme and the anxiety induced in previously asymptomatic family members who did not realize that they could be at risk. Also, the 4 adult patients with possible Marfan syndrome found it difficult to accept that a definite diagnosis could not be reached after they had been invited to attend a screening programme for a serious genetic disorder.
This report illustrates the importance of screening all the relatives of a patient with Marfan syndrome to identify previously undiagnosed cases. However, before screening a family, the physician should be aware that a clear diagnosis may not be reached in all patients, and financial, psychological or social problems may arise as a result of the screening programme.
Cervical intraepithelial neoplasia and squamous cell carcinoma of the anus in sexually active women
Authors: Dixon A R , Pringle J H , Holmes J T , Watkin D F L 
Published: December 2008

Summary
Twenty-five patients with squamous cell carcinoma (SCC) of the anus have presented over an 8 year period; 18 were female. Six of 9 patients aged under 50 years were female. Five of these women had been treated for a previous cervical malignancy (2 invasive) and 4 practised anal intercourse; human papillomavirus (HPV) type 16 DNAs were isolated from their arcival anal/cervical paraffin sections. Signals were confined to the nuclei of the invasive anal SCC cells and the transformation zone of the cervix. HPV 6, 11 and 18 DNAs were not identified. Young women with cervical intraepithelial (CIN) III or invasive cervical SCC found in association with HPV infection are at risk of developing anal SCC (P&lt;0.001; Fisher's exact).
Colonic involvement in Fabry's disease
Authors: Jack C I A , Morris A I , Nasmyth D G , Carroll N 
Published: December 2008

Summary
The case of a 54 year old man with Fabry's disease and extensive jejunal and colonic diverticulosis causing colonic stricture is presented. Histological examination of the resected colon revealed evidence of ceramide trihexose deposition in the myenteric nerve plexus. Colonic involvement in Fabry's disease has not been reported before.
Cardioversion of atrial fibrillation of recent onset with flecainide
Authors: Carr B , Hawley K , Channer K S 
Published: December 2008

Summary
Twenty-eight patients with atrial fibrillation of less than 1 month's duration were given a single intravenous bolus of flecainide (2 mg/kg). Nineteen patients (68%) were successfully converted to sinus rhythm. Of the 19 patients with atrial fibrillation of less than 72 hours duration, 18 (95%) were successfully converted. Failure to cardiovert was associated with cardiomegaly on chest X-ray and larger left atrial diameter measured echocardiographically. Of the 9 patients who failed to convert, 2 had biochemical evidence of thyrotoxicosis and chronic obstructive pulmonary disease. Of the 19 patients successfully cardioverted, the atrial fibrillation complicated acute myocardial infarction in 3 cases and a pulmonary embolism in one. Six cases occurred post-operatively and in 3 out of 6 the patient was ventilated. No side effects were observed.
The use of intravenous flecainide should avoid the need for electrical DC conversion even in sick patients. Failure of conversion is associated with covert underlying predisposing factors and duration of atrial fibrillation of more than 72 hours.
A new hypothesis for the aetiology of Crohn's disease–evidence from lipid metabolism and intestinal tuberculosis
Authors: Roediger W E W 
Published: December 2008

Summary
The stimulus for the immune response in Crohn's disease is unknown. In each of 19 cases of Crohn's disease evaluated by electron microscopy, epithelial cells of the ileum contained phagolysosomes with lamellar layers of lipid. These structures, now termed R or reactant bodies, are the proffered antigenic stimulus. They are proposed to be an amalgam of lipid (cholesterol esters, or phospholipids) and bacterial fragments (mycoplasma, mycobacteria or streptococci), which in combination are hypothesized to produce a powerful immunological response analogous to the adjuvant effect. For disease expression to occur, lipids and specific bacterial populations are needed in the bowel lumen. These factors may account for the success of elemental diets that are low in fat in the treatment of Crohn's disease and for the regional distribution of disease along the intestinal tract.
Delayed haemolytic transfusion reactions in patients with sickle cell disease
Authors: Cummins D , Webb G , Shah N , Davies S C 
Published: December 2008

Summary
We describe two cases which illustrate the difficult diagnostic and therapeutic problems posed by delayed haemolytic transfusion reactions in patients with sickle-cell disease. The cases emphasize the need for meticulous phenotypic and serological assessment of sickle-cell patients prior to transfusion therapy.
Dose response to inhaled salbutamol in chronic obstructive airways disease
Authors: Teale C , Morrison J F J , Page R L , Pearson S B 
Published: December 2008

Summary
High dose inhaled salbutamol is increasingly used in the management of chronic obstructive airways disease. To determine the range of doses to achieve optimal bronchodilatation and the proportion of patients requiring high dose therapy we have studied 23 patients with chronic obstructive airways disease. Cumulative dose responses were measured to six incremental doses of salbutamol (0.2 to 1.2 mg) delivered by metered dose inhaler. Results were analysed by polynomial regression to calculate the smallest dose required to produce 90% maximal bronchodilatation in each patient. While 5/23 (22%) required &lt; 1 mg the majority, 14/23 (61%), achieved 90% maximal bronchodilation with salbutamol 0.6 mg or less. The 8 patients with severe airflow limitation (FEV1 ⩽ 1 litre) showed a similar pattern of response.
We conclude that in chronic obstructive airways disease there are wide individual variations in the dose of inhaled salbutamol producing 90% maximal bronchodilatation with only a minority requiring high dose therapy.
Diverticulum of the rectum due to a rectal leiomyosarcoma
Authors: Hutchinson R , Gardner R D 
Published: December 2008

Summary
A 78 year old woman with a rectal leiomyosarcoma is presented. The case is of interest because of very unusual radiological and operative features of a large rectal diverticulum. As a result of the difficulty in making the correct diagnosis pre- or intraoperatively, a simple, but possibly suboptimal, resection was performed. Although the patient has done well, the long-term outlook is uncertain. The problems of optimum management and prediction of outcome in this uncommon condition are discussed.