bluuebunny/crossref_metadata_2025_split huggingface dataset:
Selenium deficiency, reversible cardiomyopathy and short-term intravenous feeding
Authors: Levy J B , Jones H W , Gordon A C 
Published: December 2008

Summary
We report the case of a patient with Crohn's disease receiving short-term postoperative parenteral nutrition supplemented with trace elements who nevertheless became selenium deficient with evidence of a cardiomyopathy. This was fully reversible with oral selenium supplementation. Current parenteral feeding regimes may not contain enough selenium for malnourished patients.
Do carotid bruits predict disease of the internal carotid arteries?
Authors: Davies Keren N , Humphrey Peter R D 
Published: December 2008

Summary
A carotid bruit is often thought of as a reliable sign of extracranial carotid artery disease. In addition finding a bruit may precipitate a referral to hospital. Carotid endarterectomy has now been shown to be beneficial in patients with symptomatic carotid territory ischaemia and 70-99% stenosis of the relevant carotid artery, therefore it is important that such patients are detected and referred.
In this study of 331 consecutive patients referred to a specialist cerebrovascular clinic we examined the practical value of a carotid bruit mentioned by the referring practitioner. All patients underwent clinical assessment, evaluation of risk factors and Doppler duplex scanning of the carotid arteries. A bruit was stated in the referral letter of 110 (33%) patients. Moderate (30-69%) or severe (70-99%) stenosis was present in 37% of patients with, and 17% of those without a carotid bruit (P &lt; 0.001). We found a carotid bruit was a poor predictor of such disease (positive predictive value, 37%). The false negative rate for severe disease was 43%. Normal carotid arteries were found in 32% of patients with a bruit. We therefore suggest that all patients with suspected carotid territory ischaemia should be referred for assessment whether there is a bruit present or not.
Aneurysm of the inferior thyroid artery
Authors: Seenu V , Baliga S , Misra M C 
Published: December 2008

Summary
A case of aneurysm of the inferior thyroid artery is presented. It is usually not possible to diagnose the exact site of origin clinically. Digital subtraction angiography can determine the precise site and type of aneurysm. In view of the high incidence of complications, early surgical treatment is recommended.
Spontaneous splenic rupture in typhoid fever
Authors: Ali Gazanfar , Kamili M A , Rashid Samia , Mansoor Aijaz , Lone Bashir A , Allaqaband G Q 
Published: December 2008

Summary
Three cases of multidrug-resistant Salmonella typhi infection presenting as spontaneous splenic rupture are presented. One patient died and two recovered completely. This is a previously unreported presentation of typhoid fever.
Phytosterolaemia in three unrelated South African families
Authors: Berger G M B , Deppe W M , Marais A D , Biggs M 
Published: December 2008

SummaryPhytosterolaemia (beta-sitosterolaemia), a rare, autosomal recessive disorder, has not hitherto been reported in Southern Africa. We report four new homozygous patients, from three unrelated families with significant beta-sitosterolaemia (6.6-11.3%), campesterolaemia (2.2-4.6%) and clearly detectable, though unquantified, levels of cholestanol. Three of the four patients had characteristic cutaneous and tendinous xanthomas within the first decade of life. The fourth patient, a 5 year old, was free of xanthomas despite persistently elevated concentrations of plant sterols in her plasma. All our patients were female bringing the male:female ratio in reported cases to 8:23. All were at or below the 50th percentile for height and weight, and presented at some stage with borderline, hypochromic anaemia associated with red cell abnormalities and thrombocytopaenia. The oldest patient showed suggestive clinical evidence of atherosclerosis affecting her aorta, ileofemoral bifurcation and possibly coronary arteries. All homozygotes responded to a diet restricted in phytosterols and the administration of cholestyramine with falls in plasma sterols of up to 68%.The recent discovery of a possible inherited defect in the synthesis of HMG CoA reductase in patients with phytosterolaemia makes this disorder a model system for studying the biological role of this enzyme in regulating the absorption and clearance of sterols other than cholesterol, and the factors governing the sterol composition of cell membranes.
Unstable angina and exposure to carbon monoxide
Authors: Balzan M V , Cacciottolo J M , Mifsud S 
Published: December 2008

Summary
Inhalation of small amounts of carbon monoxide diminishes the pain threshold in patients with stable angina pectoris. The aim of this study was to identify and describe patients who had been exposed unknowingly to toxic inhalations of this gas and subsequently presented to hospital with a clinical picture of unstable angina. Blood carboxyhaemoglobin levels of 104 patients referred with unstable angina to a coronary care unit were determined on admission. The likely source of carbon monoxide was identified in all patients. Three patients had definite carbon monoxide intoxication. Another five patients had evidence of minor exposure. When the three cases with carbon monoxide poisoning were excluded, the mean carboxyhaemoglobin level was 2.5% (+/- 1.3) for smokers (n = 30) and 0.6% (+/- 0.5) for non-smokers (n = 71). Use of fossil fuel combustion in an enclosed environment was responsible for the three most serious intoxications and one of the minor cases. We suggest that a number of patients admitted for coronary care with unstable angina may have significant carbon monoxide poisoning. This intoxication is often overlooked by attending physicians with the result that high concentration oxygen therapy is not administered, when it is in fact a necessary part of treatment.
Cardiac tamponade as the initial presentation of malignancy: is it as rare as previously supposed?
Authors: Muir K W , Rodger J C 
Published: December 2008

Summary
Advanced malignant disease frequently involves the heart and pericardium, and pericardial effusion is a common postmortem finding in such patients. Identification of pericardial effusions in life is uncommon, however, even when symptomatic. Cardiac tamponade occurring as the first presentation of malignancy appears to be uncommon.
We present five cases of cardiac tamponade due to undiagnosed malignancy which presented to a general medical unit over 18 months. The availability of echocardiography was an important factor in correct diagnosis, since clinical features were non-specific. Bronchial adenocarcinoma was the cause in three of the five cases.
Review of the literature confirms adenocarcinomas of the bronchus as the most common cause of this complication. The majority of cases have presented with large volume, haemorrhagic effusions, and cytology (with or without carcinoembryonic antigen measurement) was diagnostic in most patients. Immediate treatment with subxiphoid pericardiotomy is recommended; the role of balloon catheter pericardiotomy remains to be established. Combined chemotherapy and radiotherapy appears to extend survival, which in some cases may be prolonged.
We recommend that early echocardiography should be obtained in all patients presenting with apparent cardiac failure, since early treatment of malignant effusions provides symptomatic relief.
A comparative study of postgraduate medical education in North East Thames Region
Authors: Barker A , Scotland A D , Challah S , Gainey B , Bayley I 
Published: December 2008

Summary
As a prelude to more detailed formal contracting, North East Thames Region undertook a review to examine whether the content of postgraduate medical education (PGME) varies according to the type of hospital in which junior doctors are trained. The study covered a sample of 83 trainees at different grades in four types of hospital (postgraduate, university, district general hospital involved in off-site undergraduate medical education, and district general hospital with no formal involvement in undergraduate medical education) and was designed as a qualitative comparative study. The results of the study point to a perceived lack of structure in PGME and indicate that hospital type alone does not determine a trainees' PGME experience. Moreover, different training grades have different educational needs, which will need to be addressed under more formal contracting arrangements. The Region plans to take this work forward by convening one or more consensus conferences to examine how a more structured approach to PGME could be implemented.
Endocrine assessment of impotence—pitfalls of measuring serum testosterone without sex-hormone-binding globulin
Authors: Hardy K J , Seckl J R 
Published: December 2008

Summary
The pitfalls of measuring only total serum testosterone are illustrated by a 52 year old man whose hyperprolactinaemia was associated with normal total serum testosterone but a raised sex-hormone-binding globulin, giving a low free testosterone. Prolactin suppression with bromocriptine normalized sex-hormone-binding globulin and free testosterone, and restored potency and energy after 30 years of impotence and tiredness.
Post lumbar puncture discitis and vertebral collapse
Authors: Bhatoe H S , Gill H S , Kumar N , Biswas S 
Published: December 2008

Summary
Discitis and vertebral collapse are rare but serious complications of lumbar puncture. Clinical profile, management and course of post lumbar puncture discitis in five patients is presented. Such a complication should be kept in mind whenever any invasive procedure is carried out on the spine.
Cyclosporin A in refractory idiopathic nephrotic syndrome: 5 years clinical experience
Authors: Delaney M P , Dukes D C , Edmunds M E 
Published: December 2008

Summary
The use of cyclosporin A (Cy A) in idiopathic nephrotic syndrome, particularly lesions of focal segmental glomerular sclerosis, is controversial. A retrospective study of 10 adult patients with nephrotic syndrome treated with Cy A was performed. Histological diagnosis was established in all patients: focal segmental glomerular sclerosis (n = 6), focal global sclerosis (n = 1), mesangial proliferative glomerulonephritis (n = 1), focal proliferative glomerulonephritis (n = 1) and minimal change disease (n = 1).
All patients had previously received immunosuppressive therapy (duration of steroids 1-76 months; 35.0 +/- 12.1, mean +/- SEM). Cy A in a dose of 3-5 mg/kg/day, reduced proteinuria from 16.85 +/- 6.67 to 3.37 +/- 1.48 g/24 hours (P = 0.008), with an associated increase in serum albumin from 15.2 +/- 2.6 to 34.3 +/- 2.5 g/l (P &lt; 0.001).
In six patients steroid therapy was discontinued. Cy A was well tolerated for up to 5 years. There was no significant nephrotoxicity.
In conclusion, Cy A was effective treatment of refractory idiopathic nephrotic syndrome, including those cases with focal segmental glomerular sclerosis.
Acute renal failure with ACE inhibition in aortic coarctation
Authors: Woodmansey P A , Yeo W W , Jackson P R , Ramsay L E 
Published: December 2008

Summary
A 43 year old man with inoperable aortic coarctation and severe hypertension requiring near maximal anti-hypertensive treatment was admitted in severe heart failure. After 2 weeks of treatment the heart failure and blood pressure were incompletely controlled and angiotensin converting enzyme (ACE) inhibitor was started. Serum creatinine was normal before starting the ACE inhibitor and on discharge from hospital. The patient was re-admitted a week later with gross fluid retention and in renal failure. In the absence of alternative causes, a diagnosis of ACE inhibitor-induced renal failure was made and treatment was stopped. The patient required haemodialysis for 2 days and within 1 week the renal function had reverted to normal and has remained so for 1 year. We propose that the renal haemodynamics in severe aortic coarctation are similar to those in bilateral severe renal artery stenosis and advise caution in the use of ACE inhibitors for adults with aortic coarctation.
Adenocarcinoma of the duodenum with a duodeno-colic fistula occurring after childhood Wilms' cancer
Authors: Beales Ian L P , Scott Humphrey J 
Published: December 2008

SummaryA case of a 44 year old man with a duodeno-colic fistula secondary to an adenocarcinoma of the second part of the duodenum is described. An asymptomatic leiomyoma of the second part of the duodenum was also present. The patient had been treated successfully for a right Wilms' cancer in childhood with surgery and radiotherapy. There are no previous reports of a duodenal carcinoma arising following a Wilms' tumour and cases of gastrointestinal adenocarcinoma arising as second malignancies following Wilms' tumours are reviewed. The aetiology of duodeno-colic fistulas is reviewed. Duodenal carcinoma is a unusual cause of duodeno-colic fistulas and this case may be unique in that respect.
Chronic suppurative lung disease with associated vasculitis
Authors: Bruce I N , McAteer J A , Gardiner P V , McFarland R J , Sloan J M , Bell A L 
Published: December 2008

Summary
We report a patient with chronic bronchiectasis who developed systemic vasculitis. The patient was initially treated with immunosuppression; however, the addition of antibiotic therapy improved control of her vasculitis and the need for immunosuppression was reduced. Chronic bronchial suppuration may have an aetiological role in the pathogenesis of this condition.
Acute respiratory distress secondary to Morgagni diaphragmatic herniation in an adult
Authors: Wong N A C S , Dayan C M , Virjee J , Heaton K W 
Published: December 2008

Summary
Diaphragmatic hernias of the Morgagni type are generally thought to be asymptomatic in adults. This traditional assumption led to a delay in diagnosing a Morgagni hernia as the cause of acute respiratory distress in a chronic schizophrenic man. While Morgagni hernias are usually considered to be long-standing, we present radiological evidence of an acutely expanding hernia. The patient’s symptoms were relieved by surgical repair of the hernia. We advise caution before dismissing Morgagni hernias in adults as being long-standing and clinically insignificant.
Intra-arterial administration of adriamycin-loaded albumin microspheres for locally advanced breast cancer
Authors: Doughty J C , Anderson J H , Willmott N , McArdle C S 
Published: December 2008

Summary
Regional chemotherapy is an attractive but underevaluated method of treating locally advanced breast cancer. We have combined two novel methods of targeting by delivering a single pulse of adriamycin-loaded albumin microspheres down a radiologically placed internal mammary artery catheter. A complete response was observed and prolonged local control achieved.
Non-ulcer dyspepsia: does Helicobacter pylori matter?
Authors: Sahay P , Axon A T R 
Published: December 2008

Abstract
Non-ulcer dyspepsia is a heterogenous disorder characterised by chronic or recurrent abdominal or retrosternal discomfort lasting for more than four weeks for which no cause can be determined. Helicobacter pylori has been implicated as a potential cause in a subset of patients but the association has not been proven and H pylori eradication in patients with non-ulcer dyspepsia has had variable results. Large well-controlled studies are needed to clarify the relationship.
Syndrome X--angina and normal coronary angiography
Authors: Chauhan A 
Published: December 2008

Abstract
It is clear that angina pectoris with normal coronary arteries is a heterogeneous and ill-defined syndrome that encompasses different pathogenic entities. Differences in patient selection and in definition of ‘syndrome X’ has made comparison between different study groups rather difficult. Two decades of investigations have not revealed a specific cause of this syndrome. There is now a general belief that syndrome X probably encompasses several pathophysiological disease entities and the mechanisms involved in syndrome X remain to be fully elucidated.
Spinal cord compression by spontaneous spinal subdural haematoma in polycythemia vera
Authors: Kalina P , Drehobl K E , Black K , Woldenberg R , Sapan M 
Published: December 2008

Abstract
A woman with an eight-year history of polycythemia vera presented with numbness and weakness of both legs. A large spinal haematoma was revealed on magnetic resonance imaging which was treated clinically and which subsequently resolved.
The management of anticoagulation in patients with prosthetic heart valves undergoing non-cardiac operations
Authors: Busuttil W J , Fabri B M 
Published: December 2008

Abstract
Prosthetic valve thrombogenicity and bleeding complications associated with life-long anticoagulation are constant potential causes of morbidity and mortality following prosthetic valve implantation. The conflict between over- and under-anticoagulation is even more of a problem when other surgical interventions are required. Very few clinical trials have addressed this issue. We propose some guidelines based on the concept of risk-adjusted intensity of anticoagulation but stress the need for caution with interpretation of these recommendations.
The triple-phase response--problems of water balance after pituitary surgery
Authors: Lindsay R S , Seckl J R , Padfield P L 
Published: December 2008

Abstract
A 29-year-old woman presenting with persistent headache and oligomenorrhoea was found to have a pituitary adenoma which was treated surgically. Postoperatively she developed diabetes insipidus which resolved on treatment with desmopressin acetate. She represented 11 days post surgery with nausea and vomiting and inappropriate antidiuresis was diagnosed in an infectious diseases unit. On re-admission to our unit cranial diabetes insipidus was confirmed by water deprivation. This case demonstrates the need for careful monitoring of patients after pituitary and suprasellar surgery or head injury.
An audit of fatal acute pancreatitis
Authors: Banerjee A K , Kaul A , Bache E , Parberry A C , Doran J , Nicholson M L 
Published: December 2008

Abstract
Acute pancreatitis has a mortality of about 10%: this figure has not changed over the last 20 years. A retrospective audit of fatal acute pancreatitis was performed in a teaching hospital with a catchment population of about 750,000 patients to examine patient characteristics. Using Hospital Activity Analysis code 577.0, all fatal cases of acute pancreatitis were studied in a six-year period 1987-93. Additionally, all post mortem diagnoses of acute pancreatitis were traced. The overall post mortem rate in Nottingham at the time of the study was about 35%. All available records, X-ray and biochemical data were studied and appropriate information recorded and analysed for 65 fatal cases. Only 15% were post mortem diagnoses, lower than in previous series; 72% had respiratory and 67% had renal complications. Only 34% had been admitted to the intensive care unit. A third of patients had had surgery; 67% of these was some form of external drainage. Of the 14 patients with proven gallstone pancreatitis only three had endoscopic retrograde cholangiopancreatography; 42% of patients had idiopathic disease. Not all the patients diagnosed ante mortem had the full biochemical predicted severity criteria analysed: pO2 and calcium analysis was performed in about 80%. Pre-mortem diagnoses of pancreatitis was achieved more frequently than in other comparable series.
Dysphagia due to secondary achalasia as an early manifestation of squamous cell carcinoma
Authors: Makker H K , Chisholm R , Rate A J , Bancewicz J , Bernstein A 
Published: December 2008

Abstract
A 59-year-old man, a smoker, presented with features of airflow obstruction due to squamous cell carcinoma of central airways mimicking chronic obstructive airways disease. He also had pronounced dysphagia. Computed tomographic and magnetic resonance imaging scans showed mediastinal tumour invasion but no direct oesophageal involvement. Oesophageal manometry studies revealed that dysphagia was due to the oesophageal motility disorder, secondary achalasia.
Doubly disabled: diabetes in combination with an eating disorder
Authors: Ward A , Troop N , Cachia M , Watkins P , Treasure J 
Published: December 2008

Abstract
We present a series of patients with both an eating disorder and diabetes mellitus and compare these to a group of non-diabetic patients from the same clinic. Significantly more of the diabetic patients had previous attempts at treatment for their eating disorder. A high incidence of diabetic complications was noted with clear implications, both clinically and economically, for early intervention. The incidence of childhood trauma was lower in the diabetic than the non-diabetic group. In the majority of patients, diabetes developed before the eating disorder, suggesting that diabetes itself may provide the vulnerability and increase the risk of developing an eating disorder. Early intervention in diabetic clinics may prevent the development of serious eating disorders.
Tuberculosis of the pancreas
Authors: Varshney S , Johnson C D 
Published: December 2008

Abstract
Tuberculosis of the pancreas is extremely rare. We report a case which demonstrates the diagnostic confusion which may arise in this condition. A 55-year-old alcoholic caucasian man presented with loss of weight and obstructive jaundice. Ultrasonography, endoscopic retrograde cholangiopancreatography and computed tomography showed a mass lesion in the head of the pancreas, diagnosed as probably malignant. He underwent a Whipple’s pancreatoduodencetomy and made a good recovery. Histological examination showed typical features of tuberculosis. In the absence of other foci of active disease chemotherapy was not given. He remains well 12 months after operation.
Management of transient ischaemic attacks and stroke
Authors: Humphrey P R 
Published: December 2008

Abstract
The management of stroke and transient ischaemic attacks (TIAs) has changed greatly in the last two decades. The importance of good blood pressure control is the hallmark of stroke prevention. Large multicentre trials have proven beyond doubt the value of aspirin in TIAs, warfarin in patients with atrial fibrillation and embolic cerebrovascular symptoms, and carotid endarterectomy in patients with carotid TIAs. There seems little doubt that patients managed in acute stroke units are more likely to be independent at six months than those managed in a general medical ward. This article emphasizes the importance of basing clinical management on simple history taking and examination and appropriate investigation. This, combined with knowledge of the natural history risk of TIA and stroke and the results of randomised trials, allows individuals to be managed in the most appropriate manner. This review is designed to be a practical guide, useful in the day to day management of patients with cerebrovascular disease.