bluuebunny/crossref_metadata_2025_split huggingface dataset:
Irritant contact facial dermatitis due to nebulizer therapy
Authors: Eedy D J , Barton K , Stanford C F 
Published: December 2008

Summary
A case is reported of a patient with long-standing, severe airflow obstruction requiring long-term nebulizer therapy developing a facial dermatitis in the area bounded by the nebulizer mask. The facial dermatitis seems to be the result of the combined irritancy of the nebulizer solutions and moisture, and prophylactic measures are suggested for patients requiring long-term nebulizer therapy.
Accuracy in the clinical diagnosis of parkinsonian syndromes
Authors: Gibb W R G 
Published: December 2008

Summary
This review of Parkinson’s disease and related disorders emphasizes the difficulties of distinguishing between variants of the parkinsonian syndrome. Characteristic clinical features may remain absent for many months, but accuracy of diagnosis may be improved by considering certain presenting symptoms and signs. The main characteristics of various parkinsonian syndromes are reviewed and their major distinguishing features are emphasized. Future improvement in the precision of clinical diagnosis, especially early in the course of parkinsonian syndromes, will depend on selecting out patients with Parkinson’s disease using positive diagnostic criteria.
Pharmacokinetics of flupirtine in elderly volunteers and in patients with moderate renal impairment
Authors: Abrams S M L , Baker L R I , Crome P , White A S T , Johnston A , Ankier S I , Warrington S J , Turner P , Niebch G 
Published: December 2008

Summary
The pharmacokinetics of flupirtine after a single oral dose of 100mg have been studied in patients with moderate renal impairment and in healthy elderly subjects aged 66-83 years. Mean elimination half-life of flupirtine was higher in elderly patients than in younger normal subjects, and this was associated with an increased maximum serum concentration and reduced clearance. The mean half-life in patients with renal impairment was higher than in normal subjects. There was no correlation between observed elimination half-life and degree of renal impairment, but the creatinine clearance of most patients fell in a narrow range between 43 and 60 ml/min. In the light of these results and until further information is available, it would be prudent to start treatment of patients who are elderly or have evidence of renal impairment with half the dose of flupirtine recommended for younger patients with normal renal function.
Glomerulonephritis preceding late relapse of Hodgkin’s disease
Authors: Lynn W A , Marcus R E 
Published: December 2008

Summary
We report a case of focal sclerosing glomerulonephritis which developed 11 years after successful treatment of nodular sclerosing Hodgkin’s disease. Hodgkin’s disease relapsed 7 months later and responded completely to combination chemotherapy with simultaneous improvement in renal function. This case shows that relapse of Hodgkin’s disease may occur after a 10 year interval and furthermore it may preceded by nephrotic syndrome. Renal disease in such cases may not recover until the underlying Hodgkin’s disease is treated.
Biliary colic after micro dieting
Authors: Green N J , Fowlis G A , Chadwick S J D 
Published: December 2008

Summary
A 33 year old man presented with biliary colic and transient obstructive jaundice. In the 4 weeks preceding admission he had been taking a very low calorie diet (the Cambridge Diet) and celebrated achieving his target weight with a fatty meal on the morning of admission. An ultrasound of the gallbladder suggested biliary sludge. We suggest that he developed the biliary sludge as a consequence of calorie restriction and that, following the fatty meal, the gall bladder contracted causing biliary colic and transient obstructive jaundice.
Rifampicin-induced adrenal insufficiency in the acquired immunodeficiency syndrome: difficulties in diagnosis and treatment
Authors: Ediger S K , Isley W L 
Published: December 2008

Summary
Rifampicin, an antituberculous drug, causes increased hepatic metabolism of steroid hormones. We report the case of a patient with the acquired immunodeficiency syndrome treated with rifampicin who had a ‘normal’ screening test for adrenal insufficiency, yet had clinical evidence of adrenal failure. Diagnostic testing could not be completed due to lack of clinical response to dexamethasone. Both of these findings are due to the unique effects of rifampicin on steroid metabolism.
Progressive hypokalaemia in elderly patients taking three thiazide potassium-sparing diuretic combinations for thirty-six months
Authors: Sawyer N , Gabriel R 
Published: December 2008

Summary
Three different thiazide potassium-sparing diuretic combinations were given to elderly patients for heart failure. Eighty patients received their allocated combinations for 3 years and had 6-monthly measurements of plasma potassium. A further 84 were recruited for study but 29 died within 6 months and 55 had to be withdrawn from the trial. The triamterene-containing preparation was discontinued most frequently (6/44) because of hypokalaemia (plasma potassium less than 3.0 mmol/l); amiloride (5/44) and spironolactone (1/47). The median fall in plasma potassium over 3 years in those patients not withdrawn because of hypokalaemia was similar in each case (P greater than 0.05) and possibly failed to reach significance because of the withdrawal rate (9%). The trend was for a greater fall in those patients taking triamterene. The spironolactone-containing preparation may be the least unsatisfactory of the three.
Medical organisation and training in Switzerland
Authors: Zulian G B 
Published: December 2008

Summary
This paper aims to report on a successful medical system in a very successful country, politically organized as a federal republic, which put 12 billion Swiss francs in its Health budget in 1980. It also reports on the training of Swiss physicians with special reference to internal medicine and emphasis on their independence. The benefit of close collaboration between the public and the private sector should appear obvious even if this situation might be jeopardized by too many new graduates for fewer patients.
Beryllium disease
Authors: Jones Williams W 
Published: December 2008

Summary
The increasing use of beryllium in a variety of industries continues to be a hazard. New cases are still being reported to the UK Beryllium Case Registry, now numbering 60 in the period 1945-1988. The majority of cases follow inhalation which results in acute beryllium disease (chemical pneumonitis) or more commonly chronic beryllium disease--a granulomatous pneumonitis. Granulomatous skin nodules also occur following local implantation. The clinical and radiological features are briefly described with the emphasis on pathology and immunology. Laser microprobe mass spectrometry analysis of tissue sections is a major advance in diagnosis. Detection of beryllium distinguishes the granulomas of chronic beryllium disease from other diseases, in particular sarcoidosis. The role of beryllium lymphocyte transformation tests is discussed. Chronic beryllium disease is steroid dependent and local excision of skin lesions appears to be curative. There is no evidence that beryllium is carcinogenic.
Rickettsial infection presenting as culture-negative meningitis
Authors: Woo M L , Leung J W C , French G L 
Published: December 2008

Summary
Meningitis is an unusual presentation of rickettsial infection. We report a patient who was confirmed by serology to have typhus fever (not scrub), but who presented with the typical findings of culture-negative bacterial meningitis. Neurological manifestations of different types of rickettsial infection are discussed.
Does cyclosporin A adversely affect Pneumocystis carinii infection?
Authors: McGonigle R J S , Beaman M , Stone J , Young J , Michael J , Adu D 
Published: December 2008

Summary
Fourteen immunosuppressed patients with Pneumocystis carinii infection presented in two clusters that were separated by 2 years. The diagnosis in all cases was made early by alveolar lavage with cytology. The first group of seven patients was immunosuppressed with cyclophosphamide or azathioprine and prednisolone. All recovered with high dose co-trimoxazole. The second group of seven patients was on prednisolone and cyclosporin A. Despite identical treatment three patients died and a further two who survived lost their grafts from rejection. Our data suggest that cyclosporin A adversely affects the prognosis from Pneumocystis carinii infection and raises the question of prophylactic co-trimoxazole in these patients. The clustering of Pneumocystis carinii infection suggests the possibility of nosocomial transmission although in this study we were unable to implicate person-to-person spread of infection.
Clinical and laboratory responses to niceritrol in the treatment of hypercholesterolaemia
Authors: Curtis L D , Reckless J P D , Winder A F , Betteridge D J 
Published: December 2008

Summary
Twenty-five hypercholesterolaemic patients from three centres in the UK were investigated in an open study of the efficacy and side effects of niceritrol. Five patients dropped out of the study at an early stage and had insufficient data for analysis. There were 13 males and 7 females (mean age 49.2 years, range 18-69). Fourteen patients had heterozygous familial hypercholesterolaemia, and six polygenic hypercholesterolaemia. Niceritrol was started at a dose of 750 mg/day and this was increased at weekly intervals over 4 weeks to the maximum tolerated dosage up to 3 g/day. This was then maintained for a further 8 weeks. There were statistically significant decreases in total plasma cholesterol, total triglyceride, LDL cholesterol and VLDL triglyceride; HDL cholesterol remained unchanged after 12 weeks of treatment (Wilcoxon matched pairs, signed ranks test). The 14 patients with familial hypercholesterolaemia showed a 13.9% fall in total cholesterol and a 19.8% fall in LDL cholesterol. All patients reported flushing and some had gastrointestinal symptoms but 19 would have been prepared to continue with the therapy at doses up to 3 g/day. Thus niceritrol has been found to be beneficial in the treatment of both familial and polygenic hypercholesterolaemia.
Use of exercise Doppler for non-invasive haemodynamic optimization of dose and identification of poor responders to an oral anti-anginal agent. A double-blind dose-finding study of nisoldipine
Authors: Singer M , Trotman I F 
Published: December 2008

Summary
Nisoldipine, a new dihydropyridine calcium antagonist, was examined for its dose-related haemodynamic effects using exercise-induced changes in aortic blood flow as measured by Doppler ultrasound. Following a two-week placebo run-in, 24 patients with stable angina pectoris were assigned double-blind to one of three groups receiving doses ranging from 2.5-20 mg/day over 8 weeks, given once or twice daily. Doppler studies identified the low dose group as responding less well at the placebo phase compared to the other two groups. There was an overall improvement in percentage change of peak velocity and stroke distance with exercise at all doses, with a dose of 5 mg/day giving optimal benefit in both variables (P less than 0.05) and no additional benefit being seen on twice-daily dosage. Six patients reporting increased chest pain exhibited a significantly worse rise in peak velocity and a fall in stroke distance to exercise (P less than 0.05) whilst on active drug compared to those who responded favourably. Doppler ultrasound can be of benefit in the haemodynamic assessment of new drugs, the recognition of non-responders and the optimization of therapeutic regimes.
Severe disseminated intravascular coagulation associated with massive ventricular mural thrombus following acute myocardial infarction
Authors: Solomon S A , Cotton D W K , Preston F E , Ramsay L E 
Published: December 2008

Summary
We describe three patients who developed severe disseminated intravascular coagulation associated with large ventricular mural thrombi shortly after presenting with acute myocardial infarction. To our knowledge this association has not been reported before.
Familial breast cancer
Authors: Phipps R F , Perry P M 
Published: December 2008

Summary
Familial breast cancer is important because of all the known risk factors associated with developing the disease. The one with the most predictability is a positive family history. It is also important because a family history causes anxiety in the families concerned, and young women will often ask their chance of developing the disease. This form of breast cancer accounts for 10% of causes and has factors that distinguish it from the sporadic variety. Relatives of familial breast cancer patients are not only at an increased risk of developing the disease (if female) but also of developing other tumours especially colonic.
Coeliac disease and pernicious anaemia
Authors: Ng J P , Green S T , Lam D C , Shahriari S 
Published: December 2008

Summary
Despite the often reported autoimmune basis for coeliac disease and pernicious anaemia, there have been only occasional reports of the two conditions occurring together. We wish to report of such an association occurring in a 61 year old patient and comment on the diagnostic and prognostic implications.
Benign tumour of the ampulla of Vater presenting with portal hypertension
Authors: Aitken P , Erwin L , Fulton J D 
Published: December 2008

Summary
Benign tumours of the ampulla of Vater are uncommon and usually present with obstructive jaundice. This is believed to be the first report of anicteric portal hypertension and hypersplenism caused by a benign ampullary tumour.
Hypopituitarism in the elderly in the presence of elevated thyroid stimulating hormone levels
Authors: Beringer T , McClements B , Weir I , Gilmore D , Kennedy L 
Published: December 2008

Summary
Two cases of primary hypothyroidism with hypopituitarism in elderly patients are reported. The elevated levels of thyroid stimulating hormone led to delay in the recognition of accompanying pituitary failure. Elderly patients should not be commenced on thyroxine replacement therapy until the possibility of hypopituitarism and cortisol deficiency has been excluded.
Spontaneous subcutaneous and mediastinal emphysema--a complication of lung function tests in Pneumocystis carinii pneumonia
Authors: Ramakrishnan S , MacLeod P M , Tyrell C J 
Published: December 2008

Summary
A case is described of subcutaneous and mediastinal emphysema developing as a complication of lung function tests in an immunocompromised patient with presumed Pneumocystis carinii pneumonia.
Acute inflammatory demyelinating polyradiculoneuropathy presenting as complete heart block and Stoke-Adams attacks
Authors: Wani B A , Misra M , Shah M , Mufti S 
Published: December 2008

Abstract
A patient with acute inflammatory demyelinating polyradiculoneuropathy (AIDP, Guillain-Barré syndrome) whose presenting complaints were related to autonomic dysfunction in the form of parasympathetic and sympathetic overactivity is reported. Parasympathetic overactivity was severe enough to cause complete atrioventricular block (atropine-responsive) and Stoke-Adams attacks, for which a demand pacemaker was required. Limb weakness was apparent 48 hours later. To our knowledge no such presentation of AIDP has been previously recorded.
Hypersplenism due to fungal infection of spleen in a successfully treated patient with Hodgkin’s disease
Authors: Raina V , Young P T , Foulis A K , Soukop M 
Published: December 2008

Abstract
A 58 year old woman, with dermatitis herpetiformis was found to have Hodgkin’s disease following the discovery of an abdominal mass and splenomegaly. Combination chemotherapy was given. Although the abdominal mass and systemic symptoms resolved, the splenomegaly did not and the patient developed severe prolonged anaemia and pancytopaenia. Splenectomy resulted in a complete reversal of the haematological abnormalities. Histopathological examination of the spleen revealed fungal granulomas of Candida albicans. No residual Hodgkin’s disease was found. The patient thus had hypersplenism due to fungal granulomas in the spleen. This form of presentation of fungal granuloma is very rare and resulted in delay in diagnosis and considerable morbidity to the patient.
Vascular injury after arterial catheterization
Authors: Groome J , Vohra R , Cuschieri R J , Gilmour D G 
Published: December 2008

Abstract
Twenty-three cases of arterial injury after 8,208 arterial catheterizations for diagnostic or therapeutic indications at Glasgow Royal Infirmary are reviewed. Clinical presentation included haematoma formation, development of an acutely ischaemic limb or a false aneurysm. Patients with valvular heart disease are identified as a high risk group. Nine cases were managed by simple suture of the puncture site whereas thrombectomy and vein patch closure was required in 12 patients. The incidence of late complications requiring vascular reconstruction was 9%. The early recognition of complications after arterial catheterization and prompt referral to a specialized vascular unit is essential if morbidity is to be avoided.
Parathyroid hormone and anaemia--an erythrocyte osmotic fragility study in primary and secondary hyperparathyroidism
Authors: Foulks C J , Mills G M , Wright L F 
Published: December 2008

Summary
Parathyroid hormone (PTH) has been shown in vitro to enhance erythrocyte osmotic fragility (EOF) and has been incriminated as a factor in the anaemia seen in patients with primary hyperparathyroidism and in patients with renal disease and secondary hyperparathyroidism. Enhanced EOF has also been shown in patients with chronic renal failure but did not correlate with PTH levels. We studied a group of patients with primary hyperparathyroidism with and without anaemia, and patients with secondary hyperparathyroidism and anaemia. We found that EOF studies in these patients did not differ from normal control groups and that there was no relation between PTH, EOF, and haematocrit in either study group. We conclude that PTH over a range of concentrations seen in vivo does not affect erythrocyte osmotic fragility or cause anaemia.
Anthraquinone laxatives and human cancer: an association in one case
Authors: Patel P M , Selby P J , Deacon J , Chilvers C , McElwain T J 
Published: December 2008

Summary
An 18 year old girl presented with a leiomyosarcoma of the small bowel with widespread dissemination. Despite short term remissions after chemotherapy and surgery she died of the disease 10 months later. A history of prolonged exposure to danthron (an anthraquinone laxative) in childhood was obtained. Anthraquinones are known to be mutagenic and may be carcinogenic in experimental systems but danthron is not a proven carcinogen in man. The association of danthron and a rare bowel cancer in one case cannot prove a causative link. However, collection of further data seems advisable.
The relevance of anatomy and morbid anatomy for medical practice and hence for postgraduate and continuing medical education of doctors
Authors: Crisp A H 
Published: December 2008

Summary
A case is presented for the durability of anatomy including dissection of the cadaver and of morbid anatomy as elements in medical education and practice. It is these subjects, as consistently relevant over the centuries for medical practice as are communication skills, that are our hallmark as doctors. It is submitted that we should take stock very carefully of their relevance to us before it is too late easily to redress the balance, given the major trends of the last two decades.
Artefacts associated with a cryoglobulin
Authors: Hambley H , Vetters J M 
Published: December 2008

Summary
A 70 year old man is described in whom the presence of a cryoglobulin caused a number of unusual laboratory features which were not recognized as being due to a cryoglobulin initially. Pseudoleucocytosis has been recognized in the past. However, the intracytoplasmic inclusion bodies have only rarely been described. The curious appearance of the ESR has not previously been described.
Bladder outflow obstruction induced by ipratropium bromide
Authors: Lozewicz S 
Published: December 2008

Summary
Three cases are described in which bladder outflow obstruction was produced by ipratropium bromide, a widely used anticholinergic bronchodilator which has been regarded as virtually free from systemic side effects. Many patients treated with ipratropium bromide are elderly males in whom prostatic hypertrophy is common and in these circumstances, large doses should be used with caution.
The cost of chronic dialysis in multiple myeloma
Authors: Coward R A 
Published: December 2008

Summary
The complications and costs of chronic dialysis in 4 patients with renal failure due to multiple myeloma are presented. In three patients the paraprotein responded to chemotherapy though without recovery of renal function. These three patients are alive after 18, 16 and 15 months of dialysis, the other dying after 7 months. Hospital admissions ranged from 26 to 74 days per year with infections accounting for 54 to 87% of admission days, 62.5% of which occurred during the first three months of dialysis treatment, with an incidence of 2.4 to 6.9 admissions episodes per year.
An in-house audit of our chronic dialysis patients indicated that treatment of myeloma patients is 5-33% more expensive. The extra cost in such high risk patients is mostly due to the greater number and longer duration of hospital admissions for infection. The other extra costs (in decreasing value) of blood products, antibiotics and chemotherapy are relatively small in comparison to in-patient treatment.
Visual hallucinations in the elderly associated with the use of levodopa
Authors: Banerjee A K , Falkai P G , Savidge M 
Published: December 2008

Summary
Visual hallucinations are a well recognized unwanted effect of treatment with levodopa. Although many individual cases have been reported, there has only been one review previously published about this finding, and this did not discriminate age groups. We present five cases and briefly review the literature. It is important to enquire specifically about visual hallucinations in patients on levodopa therapy at follow up, as this otherwise potentially reversible side effect may be overlooked.
Riedel’s thyroiditis associated with hypothyroidism and hypoparathyroidism
Authors: Marín F , Araujo R , Páramo C , Lucas T , Salto L 
Published: December 2008

Summary
Hypoparathyroidism secondary to Riedel’s thyroiditis is rare, only 2 previous cases having been reported. We present the case of a 36 year old woman with Riedel’s thyroiditis which developed into hypothyroidism and hypoparathyroidism.
Lack of efficacy of phenytoin in the syndrome of inappropriate anti-diuretic hormone secretion of neurological origin
Authors: Decaux G , Przedborski S , Soupart A 
Published: December 2008

Summary
Phenytoin has been proposed in the management of patients with the syndrome of inappropriate secretion of anti-diuretic hormone (SIADH) of neurological origin who fail to respond to water restriction.
We have conducted a prospective study in order to evaluate the role of phenytoin in the management of seven consecutive patients with SIADH of neurological origin which could not be controlled by limited water intake. Only one patient was successfully treated with chronic phenytoin regimen. This patient, like one previously reported, had suffered a basal skull fracture. It seems likely that in the majority of cases of SIADH of neurological origin phenytoin is ineffective on a long-term basis.