Postgraduate Medical Journal

Editorial Board

EditorCharles RK Hind,Liverpool

Editorial OfficeElizabeth J Young,London

Technical EditorSue J Peter,Ringwood

M Aghiad Al-Kutoubi,London

Peter J Bames, LondonAnthony H Bamett, BirminghamMalcolm C Bateson, Bishop AucklandJohn G Bligh, LiverpoolChristopher J Bulpitt,London

D John Coltart, LondonGordon C Cook, LondonGill Gaskin, LondonJ Clive Gingell, BristolBarry I Hoffbrand, London

David Ingram, LondonColin D Johnson, SouthamptonRose Anne Kenny, NewcastleGraham Leese, DundeePeter H Millard, LondonMichael WN Nicholls, LondonMaurice Super, ManchesterJ Allister Vale, BirminghamTom Walley, LiverpoolPhilip D Welsby, EdinburghPeter R Wilkinson, Ashford,

Middlesex

International EditorialRepresentativesNestor Angomachalelis,

Thessaloniki, GreeceClive S Cockram,NT Shatin, Hong Kong

Jan Willem F Elte,Rotterdam,The Netherlands

Frederick F Fenech,St Julians, Malta

B Monappa Hegde,Mangalore, India

Peter Tugwell, Ottawa,Ontario, Canada

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Published by theBMJ Publishing Group

Typeset byElite Typesetng Techniques,Eastleigh, Hants

Printed inGreat Britain on Acid-Freepaper by CambridgeUniversity Press

The Postgraduate Medical Journal is published onbehalf of the Fellowship of Postgraduate Medicineby the BMJ Publishing Group.

The Journal, as the organ of the Fellowship ofPostgraduate Medicine, is dedicated to advancingthe understanding and practice of postgraduatemedical education and training. The Fellowship ofPostgraduate Medicine was founded after the FirstWorld War and was a pioneer in the UK in thedevelopment of programmes of postgraduate studyin all branches ofmedicine (see PostgradMed J7 1985;61: 1). It always has been, and remains, independentof University, Health Service and Govemment.Currently the Fellowship works closely with theNational Association of Clinical Tutors in furtheringmutual aims. Amongst other activities, the Fellow-ship provides research grants and support for younginvestigators, especially those working temporarilyin the UK.

Further details of the Fellowship of PostgraduateMedicine can be obtained from The ExecutiveSecretary, Fellowship of Postgraduate Medicine,12 Chandos Street, London WIM 9DE, UK.

The Joumal is covered by Current Contents,Biological Abstracts, ASCA, ISIIBIOMED, IndexMedicus, Excerpta Medica and Science CitationIndex.

EditorialManuscripts, initial supplement enquiries, and alleditorial correspondence should be sent to: TheEditor, Postgraduate Medical j3ournal, 12 ChandosStreet, London WIM 9DE, UK (tel: +44 171 6366334; fax: +44 171 436 2535).

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PublisherAll business correspondence and reprint requestsshould be addressed to Postgraduate MedicalJournal, BMJ Publishing Group, BMA House,Tavistock Square, London WC1H 9JR, UK(tel +44 171 383 6305).

SubscriptionsPostgraduate Medical Journal is published monthly.The annual subscription rate is £175 worldwide.Orders should be sent to the Subscription Manager,PostgraduateMedicaljournal, BMA PublishingGroup,PO Box 299, London WC1H 9TD, UK. Orders canalso be placed with any leading subscription agent orbookseller. Subscribers maypayfortheirsubscriptionsby cheque (payable to British Medical Joumal) or byAccess, Visa, orAmerican Express by quoting on theirorder the credit or charge card used, together with theappropriate personal account number and the expirydate of the card. (For the convenience of readers inthe US subscription orders with or without payment($271) may also be sent to BMJ Publishing, PO Box590A, Kennebunkport, ME 04046, USA. Allenquiries, however, mustbe addressed to the publisherin London.) The personal subscription rate is £80($124). Personal subscriptions can only be accepted ifthe order is accompaniedbyapersonal cheque or creditcard number.

Copyright© 1997 The Fellowship of Postgraduate MedicineISSN 0032-5473

All rights reserved. No part of this publication maybe reproduced, stored in a retrieval system, ortransmitted in any form or by any means, electronic,mechanical, photo-copying, recording or otherwise,without prior permission of the Publisher.

US periodicals postage paid at Rahway NJ. Post-master: send address changes to: PostgraduateMedical joumnal, c/o Mercury Airfreight Inter-national Ltd Inc, 2323 Randolph Avenue, Avenel,NJ 07001, USA.

Whilst every effort is made by the publishers and editorial board to see that no inaccurate or misleading data, opinion orstatement appears in this Journal, they wish to make it clear that the data and opinions appearing in the articles andadvertisements herein are the responsibility of the contributor or advertiser concerned. Accordingly, the publishers and TheFellowship, the editorial committee and their respective employees, officers and agents accept no liability whatsoever for theconsequences of any such inaccurate or misleading data, opinion or statement. Whilst every effort is made to ensure that drugdoses and other quantities are presented accurately, readers are advised that new methods and techniques involving drugusage, and described within this Journal, should only be followed in conjunction with the drug manufacturer's own publishedliterature.

Postgrad Med J 1997; 73: 839 (C The Fellowship of Postgraduate Medicine, 1997

International Postgraduate Diary

Royal Free Hospital School of Medicine9-13 February, 8-12 June, 12-16 October1998: MRCP Part II courseDetails: DG J7ames, Department of Medicine,Royal Free Hospital, Pond Street, London NW32QG, UK Tel +44 171 830 2108

Society for Endocrinology23-26 March 1998: 17th Joint meeting ofBritish Endocrine Societies (Heriot WattUniversity, Edinburgh, UK)Details: Society of Endocrinology, 17118 TheCourtyard, Woodlands, Almondsbury, BristolBS12 4NQ, UK Tel +44 1454 619036; fax+44 1454 616071

Obstetric Anaesthetists Association1-3 December 1997: 3-Day course onobstetric anaesthesia and analgesiaDetails: OAA Secretariat, PO Box 3219,London SW13 9XR, UK Tel +44 181 7411311; fax +44 181 741 0611

Osler Club of London (evening meet-ings)11 December 1997: Sleep in art and history8 January 1998: Presidential address5 February 1998: Members' papersDetails: Royal College of Physicians, RegentsPark, London NWJ 4LE, UK

Havering Hospitals MRCP Part IIcourses13/14 December 1997: written course3 January 1998: written crammer

7/8 February 1998: clinical courseDetails: Dr G Smith, Department of Gastro-enterology, Oldchurch Hospital, Romford, EssexRM7 OBE, UK Tel +44 1708 708224

Falk Symposia29/30 January 1998: Normal and malignantliver cell growth workshop (Halle, Germany)14-19 February 1998: VII Gastroenterologyweek (Titisee)27-29 February 1998: Complications of livercirrhosis (Bonn)5-7 March 1998: Induction and modulationof gastrointestinal inflammation (Saarbriuck-en)Details: Falk Foundation eV, Congress Division,PO Box 6529, D-79041 Freiburg, Germany.Tel +49 761 130340; fax +49 761 1303459

University of California, San Francisco6/7 December 1997: Stabilization and man-agement of the critically ill child12/13 December 1997: Annual advancedseminar in urologic surgery: strategies inoffice-based urology24 January 1998: Behavioral/developmentalpediatrics6 February 1998: Annual Paediatric UrologySeminar11-13 February 1998: 31st Annual Recentadvances in neurology

19-21 February 1998: CardiovascularHealth: coming together for the 21st century19-21 February 1998: Epidemiology andprevention of infectious diseases19-22 March 1998: Therapeutic and pro-phylactic uses of nucleic acids23-25 April 1998: International bladderresearch congressDetails: University of California, Office ofContinuing Medical Education, 1855 FolsomSt, MCB Room 630, San Francisco, CA94143-0742, USA. Tel +1 415 476 4521;fax +1 415 476 0318

Barrow Neurological Institute8-11 March 1998: 24th Annual symposiumon recent advances in neurology, neurosur-gery and neuroradiology (Phoenix, Arizona,USA)Details: Denise Eskildson, Neuroscience Confer-ence Coordinator, Barrow Neurological Institute,350 West Thomas Road, Phoenix, AZ 85013,USA. Tel +1 602 406 3067; fax +1 602 4064104

Egyptian Society of Cardiology, 25thAnniversary meeting22-27 February 1998: Cairo, EgyptDetails: 98 Mohamed Farid Street, Cairo,Egypt. Tel +20 2 337 5632; fax +20 2 3602800

Postgrad Med J 1997; 73: 840 - 842 (© The Fellowship of Postgraduate Medicine, 1997

AUTHOR INDEXKey: (E) = Editorial; (L) = Letter; (BR) = Book Reviewer

AAbad A, 185Aggarwal P, 361, 671Aguado P, 185Ah-Fat FG, 191 (BR)Ahmed AR, 776Ahmed Z, 421, 821Ahuja AT, 412Akasheh M, 677Al-Attia HM, 667, 802, 821Al-Hillawi AH, 188 (L)Al-Kutoubi A, 827Al-Kutoubi MA, 129, 525 (L)Al-Mohammad A, 301Al Murawy M, 667Al-Omishy H, 125Alcalde J, 185Alcalde M, 295, 51Alikasifoglu M, 679Allan RN, 225Allen CMC, 254 (L)Allen SC, 183Alvarez A, 732Andrews FJ, 601Appleby CA, 415Aragon G, 580Arici M, 589Arya NC, 121Asano M, 379Aslam S, 573Asscher, Sir William, 191 (BR)Asselah T, 751Atherton MT, 65Auget T, 371Avivi I, 245Awad I, 557Ayonrinde OA, 190 (L)Azhar R, 595Azuara MV, 51

BBacon NCM, 433Badesha PS, 101Baithun SI, 171Baker LRI, 647Bakheit A, 529 (E)Ball JB, 141Ballinger AB, 365Balzan MV, 189 (L)Banerjee A, 86Banerjee B, 351Banjar A, 45Banning AP, 491Barnes RMR, 837 (BR)Barrett P, 817Bates AW, 171Bateson MC, 717Battin M, 243Batty GM, 720Bay6n AM, 185Beaulieu R, 403Bel M, 371Beldarrain MG, 251Bell JA, 669Ben-Bassat I, 375Benbow S, 241Benekli M, 575Bennett JR, 32Beringer TRO, 657Bhan S, 341, 525 (L)Bhandarkar DS, 313Bhamagar NK, 107Bialas MC, 519, 764Biggart SA, 597Blaut K, 582Bligh J, 449Bligh JG, 701Bloom SR, 207Boj E, 582Borland C, 299, 687 (L)Boruchowicz A, 751Bourke W, 119Bovill BA, 254 (L)Bowsher D, 623Box SA, 53Boyle S, 109Brack MJ, 377Bradshaw MJ, 175Brady AJB, 465 (E)Brambleby P, 279Braverman I, 753Breckenridge AM, 385 (E)Brid NS, 355Bridgewater B, 98Brigley 5, 23Brook JG, 245, 591Brown P, 453Brown SA, 825

Bruce-Jones PNE, 183Bryan NP, 47Bucknall R, 93Bulpitt CJ, 613Burke M, 527 (BR)Bums-Cox N, 553Busuttil DP, 435Buyukasik Y, 589Byatt CM, 476Byrne JPH, 65

C(Cagatay T, 159Cahill MR, 201Cain D, 605 (BR)Calatayud A, 303Calder F, 363Campo JF, 779Cant6n A, 357Capelastegui A, 251Carey PD, 645Carpenter MR, 119, 571Carr R, 825Carter P, 359Casals C, 599Caslin AW, 313Castro E, 117Cattell R, 255 (L)lelikoglu F, 159Celikoglu SI, 159Chadfield-Mohr SM, 476Chambler AFW, 660Chan HCK, 347Chan HM, 236Chan JTS, 167Chan WWM, 137Chapman-Sheath PJ, 660Chapnick EK, 61 (L)Chappell M, 179Chataway SJS, 593Chauhan A, 655Cheng TO, 606 (L)Cheriex EC, 710Cheung Y-C, 651Child DF, 349Chilvers ER, 305Chisholm EM, 739Chitkara N, 757Chong W, 234Chow CC, 39Chrystal V, 230Chuah SY, 177Cid J, 599Clague RB, 829Clarke D, 823Clearkin R, 603Clements WDB, 369Coates R, 279Cockerell OC, 441Cockram CS, 39Coleman B, 607 (L)Coles C, 607 (L)Coll E, 599Coltart DJ, 597Colvin BT, 201Copplestone JA, 435Cordido F, 732Corris PA, 603Corvilain B, 686 (L)Coulson R, 385 (E)Coyle PV, 307Crasset V, 337Creek RA, 496Crilley JG, 415Critchley M, 399Crockard HA, 381Cronin CC, 239Cronin P, 606 (BR)Croxson SCM, 611Currie C, 836 (L)

Dda Silva GA, 515Daniels SR, 81Dannon PN, 834Davidson BR, 125Davies A, 415Davies AG, 815Davies JS, 836 (L)Davies MG, 435Davis GK, 377Dawson LK, 305de Belder MA, 415de Silva R, 557, 649de Weerd AW, 445Delcourt E, 337Delicata RJ, 645Demirci S, 159

Demiroglu H, 679Dennis M, 755Derodra JK, 587Dev S, 171Dheer V, 757Dhillon S, 151Diaz P, 295Dickson AP, 169Diffey BL, 717Dillon J, 649Dimitriadis A, 662Dimitriadou A, 617Doig CM, 169Doig J, 743Domingo A, 323Dominiczak AF, 630Donaldson DR, 739Donckier J, 653Dorao M, 117Doyle T, 105Drake WM, 639Dundar S, 589, 679

EEchevarria S, 779Edgar WM, 93Edmunds E, 794Egleston C, 57Eliashar R, 753Ellis SJ, 193 (E)Emura S, 749Enevoldson TP, 8Engel A, 591Engels LGJB, 99Enoki M, 749Erdins 0, 127 (L)Evans C, 767 (BR)Evans JD, 543Evans RM, 311Evans S, 831Eyal A, 591

FFarooqui A, 179Farrugia M, 549Farthing MJG, 365Fearon KCH, 305Feely J, 509Fennerty AG, 156Fernandes JG, 27Ferner RE, 684Ferriss JB, 239Field EA, 93Filho JT, 515Findlay C, 557Finkelstein R, 245Fitzmaurice DA, 439Flanigan TP, 713Fl6rez J, 371Font C, 599Forrest D, 63 (BR)Fox K, 437Foy CA, 271Francis CY, 1Frankart L, 653Franklin J, 57Fraser WD, 69, 496Freestone S, 53Friedman G, 466Fulton JD, 62 (L)

GGarcia-Diaz M, 51, 295Garcia-Monco JC, 51Garcia-Pardo G, 371Garden A, 838 (BR)Garg P, 757Gattee OB, 667Gautam A, 121Gavin C, 419Gaya AM, 739Gbolade BA, 525 (L), 687 (L)Geelhoed-Duijvestijn PHLM, 445George A, 606 (BR)George DK, 311Gerrand CH, 113Gibson JM, 344Gibson M, 827Gil L, 357Gilanders IA, 62 (L)Gilbert TJ, 726Gilchrist WJ, 505Gill G, 241Gill GV, 640Gillen CD, 25Gingell C, 553Gittoes NJL, 684Glass H, 515

Glover SC, 565Goddard M, 57Goddard PF, 761Goel AK, 123Goh KL, 177Goldenberg I, 511Goldsmith DJA, 105G6mez L, 323Gould SR, 761Gouvas ZT, 297Graham JC, 383Grant PJ, 71Grau JM, 599Gray AJ, 189 (L)Green J, 836 (L)Grossman E, 511Guan R, 89Gucuyener D, 127 (L)Guerin JM, 585Guerra E, 251Guleria R, 681Gullu IH, 575Gunn IR, 311Gunn MC, 759Gupta A, 560Gupta V, 341Guzman-Paz MJ, 810

HHa CK, 61 (L)Hagley M, 57Hall JA, 415Hamon MD, 435Handa R, 361, 671Handa S, 163Hardern RD, 189 (L)Hareb A, 667Hargreaves MR, 726Harley A, 766 (BR)Harries-Jones R, 557Harris AC, 827Harris PE, 817Harrison JD, 303Hart G, 726Hartley JE, 297Harvey C, 369Harvey JN, 349Hatfield AG, 188 (L)Hattotuwa KL, 222Hatzitolios AI, 662Hayek T, 245, 591Hayes AJ, 705Hayes PC, 649Hayward M, 63 (BR)Haznedaroglu C, 589Henderson DC, 173Hendrickse MT, 377Herd B, 415Heredia JL, 323Hernandez JL, 779Herrin A, 779Hershko A, 466Heufelder AE, 103Hewitt PM, 517Higgins RM, 151Higgins TM, 239Higham SM, 93Hillier CEM, 327Hillis GS, 301Hillman N, 101Hilton CJ, 737Hind CRK, 181, 222Hirshberg B, 466Hofbauer LC, 103Hogarth K, 687 (L)Holdsworth RJ, 642Hollingdale J, 660Holmes J, 163Houghton J, 519Houghton T, 815Howlett DC, 549Howse M, 808Htin TS, 675Hubbard JGH, 107, 595Humphrey P, 766 (BR)Humphrey PRD, 8Hunter JM, 63 (BR)Huo Z, 173Hutchinson M, 419Huwez FU, 331

IIancu I, 834Ibarra A, 185Ibrahim AEK, 587Icao E, 503Ioannidis I, 662Ip TP, 249

Author index

Ironside JW, 593Ismail EAR, 367

JJabbar A, 607 (L)Jackson A, 47Jackson SHD, 720Jacyna M, 109Jaideep C, 428Jain PK, 560Jakate S, 325James DG, 38, 88, 155, 224, 304,

408, 490, 559, 644, 716, 801, 837(BR)

Jamison MH, 313Janjua KJ, 265Janmohamed S, 207Janssen HLA, 445Jarvis R, 190 (L)Jayne D, 98Jeffcote B, 829Jeffery KJM, 329Jeffreys R, 507Jennings KP, 301Jimenez G, 295Jindal RM, 146, 785Joarder R, 827Johansen A, 798Johnson A, 423Johnson CD, 469, 577Johnston C, 34Jolobe OMP, 189 (L), 675, 836 (L)Jonas M, 511Jones A, 59Jones CH, 115Jones HJS, 587Jones L, 761Joseph JM, 339Joshi JM, 339, 513Jowett NI, 819Jowett SG, 819Jung R, 63 (BR)

KKaczmarczyk E, 241Kaifi T, 599Kaisary AV, 691Kakoulidis DD, 297Kale MM, 355Kang JY, 89Kapoor R, 441Karanikas ID, 297Karayel T, 159Karim SN, 430Kato H, 749Kaushik P, 41Kaye L, 241Kaye SB, 93Keatinge WR, 766 (BR)Kelion AD, 669Keller N, 375Kendall-Taylor P, 737, 817Kennedy J, 243Kennedy N, 383Kenny RA, 635Ketley NJ, 215Khan AM, 169Khan IA, 659Khandekar JD, 317, 460, 523Khanna AK, 428Khatri AK, 121Khazanchi RK, 123Kho TL, 710Khurana CS, 415King AD, 412King D, 189 (L)King P, 673King W, 412Kingham JGC, 831Kingston RE, 605 (BR)Kingswood JC, 105Kirby RM, 303Kirkpatrick BL, 565Knight R, 557Ko GTC, 39Kodali VRR, 747, 829Kohner EM, 527 (BR)Kolhe NV, 513Kounanis AD, 662Koundourakis SS, 297Krishnamurthy S, 247Kulkarni AG, 355Kumar A, 671Kumar M, 428Kumar N, 373Kumar P, 741

LLal V, 735Lam K-Y, 391Lam SL, 249Langan Y, 419Lamer AJ, 254 (L)Lau CP, 249

Lau EMC, 167Lau WY, 517Lawrie H, 365Lawson RAM, 98Lear JT, 65, 538Ledson M, 767 (BR)Ledson MJ, 181Lee H, 729Lee PYC, 327Lee TG, 61 (L)Leese G, 507Leese GP, 426Leibinger F, 585Lepkifker E, 834Lewczuk A, 582Li AKC, 517Li KY, 39Li PCK, 236Uightwood R, 363Urm AG, 761rim BH, 61 (L)

Lin J, 43Lindop GBM, 505Uittlejohns P, 3Lockett C, 125Longman LP, 93Loo KT, 236L6pez-Santamaria A, 295Lorge F, 653Lutwick LI, 61 (L)Lye M, 527 (BR)Lyttle JA, 307

MMcAlister F, 836 (L)McAlister FA, 194McCarron MO, 344, 448 (L)McCollum PT, 642McDonnell GV, 307, 344Macdougall IC, 647McEwen J, 3MacFarlane IA, 191 (BR), 293, 640McGettigan P, 509McGleenon B, 321McGonigal A, 505MacGowan AP, 565MacGregor GA, 409McIntyre M, 630McKenna K, 743Mackenzie TM, 517McLellan S, 649McPhaden AR, 331Madanat F, 677Magerstadt RA, 103Main J, 808Manco JC, 515Manjunath S, 745Martin J, 109, 766 (BR)Martin L, 664Martin PJ, 8Matheson LM, 111Matsunuma A, 188 (L)Mayberry JF, 723Mead GE, 62 (L)Mead GM, 481Meadows P, 349Meehan RA, 183Mendez JV, 117Mesa J, 357Metreweli C, 412Mihaimeed F, 309Millar AB, 165Mills PR, 430Mishra RM, 55Misra MC, 123Missouris CG, 409Mittal R, 341, 525 (L)Moers AMJ, 99Moffat DF, 505Mofredj A, 585Mohan A, 681Mohyuddin Z, 421, 821Molyneux DH, 769 (E)Monakier D, 335Moncur P, 443Monie RDH, 156Monson JP, 59Moody G, 723Mooney EE, 509Mooney GA, 701Morales C, 185More RS, 639Moro R, 51, 295Morris A, 838 (BR)Morris G, 359Morrison WL, 141Morton DG, 543Moss ALH, 49Mueller M, 299Mukhija RD, 741Mukhopadhyay S, 681Mumford AD, 491Mumford CJ, 305, 593Murphy G, 664

Murphy MB, 239Murray JA, 439

NNadi HM, 367Nagaratnam N, 503Nagral A, 247Nagral S, 247Nahir M, 466Naidu S, 642Naik LP, 339Naik SK, 331Naiker IP, 30Narviez I, 51Nashi M, 351Neades BL, 17Neoptolemos JP, 543Newland AC, 215Newman-Sanders APG, 129Ng KKP, 236Nieuwenhuijs VB, 686 (L)Nkere UU, 45, 107, 595Nose T, 379Nour El Din A, 367Nye FJ, 383

0Oborne CA, 720O'Callaghan A, 481Odawara M, 188 (L), 379O'Donnell MA, 49Ogawa M, 379Ohmori K, 749Olujohungbe A, 163O'Mahoney S, 55 (L)Omari K, 677O'Neill B, 315O'Neill P, 455Oogushi K, 749Ooi CG, 69Oommen R, 647Ortega A, 357Ostermann M, 105Ozcebe 01, 589Ozdemir G, 127 (L)

pPaes T, 309Pal B, 423Palacios-Araus L, 779Pandey M, 121Paris J-C, 751Parker DR, 831Parker SG, 755Parks TG, 729Parsell G, 395Pascasio JM, 295Passmore AP, 321Patrick AW, 293Pattison RM, 49Peacock SJ, 329Pearse MF, 660Peat IM, 571Pedraza S, 117Pelly MDE, 173Pemberton M, 487Percy-Robb I, 452Perez-Maestu R, 580Peric H, 503Perry RA, 766 (BR), 794Peters FPJ, 99, 710Phillips BS, 175Picot C, 496Pike AC, 771Pillai R, 726Pirmohamed M, 462Platts JK, 349Playfer JR, 57Pohl JEF, 119Poon WS, 347Popat S, 825Powles R, 49Prabhakar S, 735Prajapati C, 175Prakash MB, 123Prasad S, 560Prentice AG, 435Prescott LF, 53

RRaanani P, 375Raftery AT, 47Rahman Z, 577Ramage JK, 437Rami-Porta R, 323Ram6n y Cajal S, 580Ramratnam B, 713Ramsey MM, 325Randeree IGH, 30Ranganath LR, 761Rathbone BJ, 759Rauf 0, 640Ravichandran D, 469Rawlins MD, 385 (E)

Raza K, 673Raza Z, 642Reddy MR, 113Redhead D, 649Rees JA, 125Reeves DS, 565Regueiro CA, 580Rehm A, 353Reid A, 156Riancho JA, 779Rice P, 369Richardson D, 115, 737Richardson L, 293Richart C, 371Richens D, 331Rimmer EM, 156Roberts DH, 377Robertson GSM, 759Rockall AG, 129Rodnight R, 27Rodriguez S, 185Rodriguez-Carballeira M, 323Romero J, 580Rose DSC, 254 (L)Routledge PA, 519, 764Rowlands D, 57Roy MK, 645Roy S, 41Rubins JB, 810Ryan S, 767 (BR), 837 (BR)

SSaah D, 753Saclarides TJ, 325Sacristin F, 732Saenz de Santamaria J, 51Saharay M, 179Sahota A, 146Sakensa S, 75Saklayen MG, 101Saks AM, 549Salas C, 580Salter RH, 191 (BR)Saltissi S, 319 (BR)Samual SA, 659Samuel I, 325Samuel LM, 111Sanchez L6pez JD, 185Sandercock PA, 649Sanderson JE, 137Sandhu SS, 691Sarda AK, 560Sardana V, 735Sarma PSA, 686 (L)Save VE, 62 (L)Sawhney IMS, 735Sawyer JP, 496Sayegh MH, 386Sayinalp N, 589Schinohoritis P, 686 (L)Scott HJ, 739Scriven AJI, 119, 571Scullion DA, 525 (L)Seedat YK, 230Seenu V, 123Selby CD, 305Sell PJ, 119Serlin M, 443Serpell JW, 333Shah PJ, 355Shah SMA, 607 (L)Shahi M, 669Sharma AK, 823Sharma SP, 741Sharpstone P, 105Shaw FE, 635Sheppard MC, 684Shetty HGM, 519, 764Shilo S, 335Shirotani M, 749Shukla VK, 121Shute K, 823Sichel J-Y, 753Siekierska-Hellmann M, 582Silvestri G, 307Simms M, 113Sim6 R, 357Simpson K, 607 (L)Sinclair AJ, 611Singh S, 243Sinha RN, 293Sinnott M, 509Sion ML, 662Siriwardena AN, 289Sirvent JJ, 371Sivakumaran M, 607 (L)Smith AG, 538Smith AI, 333Soares FA, 515Sommer A, 710Soni N, 173Sood R, 41Souka H, 363Soutar DS, 430

841

Author index

Sperber K, 319 (L)Spitzweg C, 103Stamp TC, 496Standen GR, 573Stebbing J, 606 (L)Steele IC, 321Stewart IS, 331Stewart JAD, 759Stewart MJ, 331Stone DL, 655Strahan K, 664Sundaram P, 339, 513Super M, 771Sverdlik A, 834Sweeney EC, 509Swift CG, 720Sworczak K, 582Szeto CC, 39

TTada K, 379Taggart H, 315Takashima T, 749Tames F, 443Tamhane R, 729Tammam A, 381Tandon RK, 75Taylor AVG, 813Taylor CM, 838 (BR)Taylor D, 191 (BR), 454Taylor I, 776Tehlan RN, 757Teo KK, 194, 836 (L)Tesfaye S, 241Thacker AK, 741Thaler M, 375, 511Tham TCK, 689 (E)Thava VR, 303Theuma A, 448 (L)

Thickett DR, 165Thomas AM, 448 (L)Thomas iM, 705Thomas SHL, 603Thompson CJ, 743Thorburn D, 430Thuraisingham SI, 655Thussu A, 735To KF, 517Toh CH, 283Torun S, 127 (L)Toulis EN, 662Touze I, 751Trakatelli M, 617Trakatellis A, 617Trash DB, 745Trivedi B, 339Tucker B, 647Turnbull CJ, 62 (L), 611

UUysal S, 127 (L)

VVaghjimal A, 61 (L), 319 (L), 448 (L)Vaidya B, 737, 817Vale JA, 129Valentini RP, 81van der Vleuten C, 451van Heyningen C, 62 (L)Vanhems P, 403Vargas JA, 580Varley H, 764Vassallo M, 119, 571Vassallo MT, 448 (L)Vazifdar K, 247Vella JP, 386Vermeulen A, 710Viagappan GM, 327

Vijayaraghavan S, 59Villalta J, 599Vince FP, 286Virk SJS, 794Vora J, 507Vora JP, 426Vulfsons S, 245

wWaldram MA, 113Wali JP, 361, 671Walker AB, 426Waller PC, 385 (E)Walley T, 605 (BR)Wallymahmed M, 293Walmsley RS, 225Walshaw M, 527 (BR)Walton MC, 181Wan Y-L, 651Ward B, 723Warren JB, 465 (E)Wasadikar PP, 255 (L)Watkin DFL, 531Watson ID, 443Watts RA, 605 (BR), 837 (BR)Wedderbum A, 359Wee A, 89Wells AD, 487Welsby PD, 609 (ED)Wetzel M, 449Wharton SM, 577Wheatley DJ, 331Wheeler MH, 373Whitehouse A, 35Whorwell PJ, 1Wig N, 671Wilde JT, 684Wilkinson C, 687 (L)Wilkinson P, 449

Will R, 557Williams JG, 697Williams NMA, 531Williams RJ, 353Williamson IJ, 156Willis AC, 286Winstanley P, 462Wise PH, 813Wong CK, 236Wong NW, 177Wong ST, 89Woo J, 167Woo KS, 347Wood DF, 59Wood SM, 385 (E)Woods F, 519Wooller S, 255 (L)Wright EP, 437

yYadav SR, 355Yalcin B, 679Yamashita K, 188 (L), 379Yap I, 89Yeoh KG, 89Yeung HM, 236Yeung VTF, 39Yip KMH, 43Yong A, 309Young Y, 23Yurianto H, 43Yusuf SW, 55

zZaki M, 367Zapata J,295Ziakas GN, 662Zubaran C, 27

842

Postgrad Med _t 1997; 73: 843-852 (C The Fellowship of Postgraduate Medicine, 1997

SUBJECT INDEX

AAbdominal pain, Abdominal pain associated with cranial nerve palsy

and peripheral neuropathy, 305Abnormal movements, Abnormal movements associated with

severe hyponatraemia, 503Accident and Emergency medicine

Avoidable attendance at Accident and Emergency by the elderly inHong Kong, 167

Expanding the role of the nurse in the Accident and Emergencydepartment, 17

Acetonitriles, Delayed cyanide poisoning following acetonitrileingestion, 299

Acid ingestion, Complete gastric outlet obstruction following acidingestion complicated by acute pancreatitis and disseminatedintravascular coagulation, 421

Acromegaly, Ectopic acromegaly, 349Actinomycosis, An unusual lesion of the penis, 179Acute-on-chronic intestinal ischaemia, Mesenteric revascularisa-

tion for acute-on-chronic intestinal ischaemia, 642Acyclovir (aciclovir)

Acute visual disturbance in a young adult, 307Treatable cause of lymphocytic meningo-encephalitis, 437

Addison's disease, The prevalence ofAddison's disease in Coventry,UK, 286

AdenocarcinomaAbnormal chest X-ray in a patient with carcinoma of the cervix, 671Caecal adenocarcinoma with multiple synchronous small intestinal

adenocarcinoma, 729Malakoplakia and colorectal adenocarcinoma, 171Pancreatic adenocarcinoma: why and when should it be resected?

469Adenoma, An unusual neurological problem in a patient admitted for

acute myocardial infarction, 669Adenosine, Stroke complicating adenosine perfusion imaging, 659Adipsia, Hypematraemia, 57Adrenal crisis, Hyponatraemia and spontaneous hypoglycaemia, 675Adrenal hypofunction, The prevalence of Addison's disease in

Coventry, UK, 286Adrenalectomy, Adrenocorticotropin-secreting carcinoid tumour

identified and treated 12 years after presentation with Cushing'ssyndrome, 737

Adrenocorticotropin, Diagnostic difficulties in periodic Cushing'ssyndrome, 426

Adverse drug reactionAdverse drug reaction of the month - a new series: editorial, 385Bipolar disorder associated with interferon-alpha treatment, 834Heparin-induced thrombosis, 684Hepatitis B vaccine and neurotoxicity, 462Low-grade fever after prosthetic valve insertion and captopril

therapy: an iatrogenic cause, 764Methotrexate pneumonitis in a patient with rheumatoid arthritis,

603Nitrofurantoin rechallenge and recurrent toxicity, 519

Ageing, Parkinson's disease, 257Agranulocytosis, Thyrotoxicosis and antithyroid drugs, 335AIDS

Cryptosporidiosis in persons with HIV infection, 713Medical, social, sexual, financial and ethical problems with AIDS -

a case history, 521; commentary, 522Microbiologically proven bacterial infections in AIDS, 565Neuroleptic malignant syndrome in the acquired immunodefi-

ciency syndrome, 779Ophthalmic complications of HIV/AIDS: letter, 448

Airway obstructionDirect injection of anti-cancer drugs into endobronchial tumours

for palliation of major airway obstruction, 159Large airway obstruction by a chronic dissecting aortic aneurysm in

the Marfan syndrome, 726Akathisia, The syndrome of motor restlessness - a treatable but

under-recognised disorder: editorial, 529Alcohol

Cannabis and alcohol in stroke: letter, 448Ketoacidosis and normal glucose tolerance, 743

Alcoholism, Wemicke-Korsakoff syndrome, 27Allergic granulomatous angiitis, Acute fulminant neuropathy in a

patient with Churg-Strauss syndrome, 236

SAlpha-reductase deficiency, Male pseudohermaphroditism due to5alpha-reductase-2 deficiency in an Arab kindred, 802

Amnnestic disorders, Wemicke-Korsakoff syndrome, 27Anaemia, Caecal adenocarcinoma with multiple synchronous small

intestinal adenocarcinoma, 729Andropause, The andropause: fact or fiction? 553Aneurysm, Asymptomatic murmurs, 597Angina, Chronic abdominal pain, 831Angiofoflicular lymphoid hyperplasia, Pelvic mass in a 46-year-

old man, 371Angiokeratoma corporis diffuisum, Fabry's disease: a multidisci-

plinary disorder, 710Angiosarcoma, Splenomegaly, 125Angiotensin, Reversible acute renal failure induced by losartan in a

renal transplant recipient, 105Angiotensin-converting enzyme inhibitors, The use of angioten-

sin-converting enzyme inhibitors in the treatment ofheart failurein hospital practice, 409

Ankle injury, Peripheral arterial pseudoaneurysm treated by ultra-sound-guided compression, 651

Anorexia nervosa, Diffuse soft tissue emphysema as a complicationof anorexia nervosa, 662

AnticoagulationAnticoagulants for venous thrombosis, 283: letter, 687Potentiation of the anticoagulant effect of warfarin, 439

Antiphospholipid antibodies, Thrombophilia in a man with long-standing hypogonadism, 761

Antiphospholipid syndrome, Meningismus, fever and macular rashas presenting features of the primary antiphospholipid syn-drome? 815

Antipsychotic agents, Neuroleptic malignant syndrome in theacquired immunodeficiency syndrome, 779

Antisynthetase syndrome, Drug-induced antisynthetase syndrome,165

Antithyroid drugs, Thyrotoxicosis and antithyroid drugs, 335Aortic dissection

Large airway obstruction by a chronic dissecting aortic aneurysm inthe Marfan syndrome, 726

Rash in an elderly woman presenting with collapse, 175Aplastic anaemia, Aplastic anaemia and reticulated skin hyperpig-

mentation, 679Appendix, Abdominal mass in a 19-year-old with neurofibromatosis,

325Arabs, Male pseudohermaphroditism due to 5alpha-reductase-2

deficiency in an Arab kindred, 802Arterial puncture, False aneurysm with median nerve palsy after

iatrogenic brachial artery puncture, 43Arteriovenous malformation, Solitary ileocolic arteriovenous mal-

formation: Spongostan and silk therapeutic embolisation, 295Ascites, Abdominal pain in a cirrhotic patient with ascites, 751AsiansTreatment of vitamin D deficient osteomalacia may unmask

autonomous hyperparathyroidism, 813Unsuspected thyrotoxicosis and hyperemesis gravidarum in Asian

women, 234Askin's tumour, Mass on chest X-ray, 515Aspergiliosis, A painful knee in an immunocompromised patient, 49Aspiration, Tropical liver abscess, 89Atherosclerosis

Nitric oxide and cardiovascular disease, 630Post-transplant hyperlipidaemia, 785

Atrial myxoma, Severe refractory congestive cardiac failure in anelderly man, 315

Atrial thrombus, Right atrial thrombus from deep venous throm-bosis, 639

Audit, Using audit to improve senior house officer training, 798Autoimmune disease, Corticosteroid therapy in Riedel's thyroiditis,

817Azathioprine, Treatment of progressive renal failure and nephrotic

syndrome with azathioprine and prednisolone, 647

BBacterial endocarditis, Fever and 'negative' blood cultures in an

elderly woman, 383Bacterial infection, Microbiologically proven bacterial infections in

AIDS, 565

Subject index

Bacterial peritonitis, Spontaneous bacterial peritonitis due toCorynebacterium sp: letter, 319

Barium, Barium peritonitis: a rare complication of upper gastro-intestinal contrast investigation, 297

Basal cell carcinoma, Basal cell carcinoma, 538Beh9et's disease, Hippocratic fingers in Behcet's disease, 575Bendrofluazide, Self-induced myopathy, 593Benefit:risk ratio, Quality of life as an outcome measure, 613Bezafibrate, Warfarin potentiation with bezafibrate, 657BezoarA case of plastikophagia, 243An unusual late complication of gastric surgery, 363

Biliary cirrhosis, Lethargy in a patient with cirrhosis, 177Bipolar disorder, Bipolar disorder associated with interferon-alpha

treatment, 834Blindness, Polydactyly and partial blindness, 747Blood test guidelines, Emergency blood test guidelines: letter, 62Body packer, Acute abdominal pain in a young man, 667Boerhaave's syndrome, Boerhaave's syndrome, 265Bone, Paget's disease of bone, 69Book reviews

Al-Assaf AF, Schmeme JA, eds. The textbook of total quality inhealthcare, 63

Angel A, Anderson H, Bouchard C, et al, eds. Progress in obesityresearch: vol 7, 63

Baliga R. 250 Short cases in clinical medicine, 2nd edn, 767Beaumanoir A, Bureau M, Deonna T, Tassinari CA, eds.

Continuous spikes and waves during slow sleep, 63Blackwood R, Daily B. Cardiological dilemmas, 319Browning M, McMichael A, eds. HLA and MHC. Genes,

molecules and function, 837Donald A, Stein M, eds. The hands-on guide for house officers, 606Ebrahim S, Kalache A, eds. Epidemiology in old age, 527Faux D, Ball C, eds. Medical education review, 191Ferrari R, Cash J, Maddison P, eds. Rheumatology guidebook. A

step-by-step guide to diagnosis and treatment, 605Gluckman D, Heymann MA, eds. Pediatricians & perinatology: the

scientific basis, 2nd edn, 767Hamilton AMP, Ulbig MW, Polkinghorne P. Management of

diabetic retinopathy, 527Haubrich WS. Medical meanings: a glossary of word origins, 837Higginson I, Montgomery D, Munro P. What to do in a paediatric

emergency, 837Holdaway K, ed. The healthcare management handbook, 605Holme CI. Trial by TB: a study into current attempts to control the

international upsurge in tuberculosis, 767Iserson V. Getting into a residency. A guide for medical students,

4th edn, 191Kent MAAG Medical Records Working Party. Suggestions for

record keeping, 2nd edn, 527Khaw PT, et al. Ophthalmology revision aid, 191Kiley R. Medical information on the internet. A guide for health

professionals, 838Lawton FG, Neijt JP, Swenerton KD, eds. Epithelial cancer of the

ovary, 605Lees P, ed. Navigating the NHS: core issues for clinicians, 606Lip GYH, ed. ABC of atrial fibrillation, 766Lock S, Wells F, eds. Fraud and misconduct in medical research,

2nd edn, 191MacKenzie MA. Pathophysiological aspects and clinical implica-

tions, 766Marber MS, Yellon DM. Ischaemia: preconditioning and adapta-

tion, 766Neonatal formulary. The northern neonatal network, 767Peckham M, Smith R, eds. Scientific basis of health services, 605Richards P. Learning medicine 1997. An informal guide to a career

in medicine, 837Sackett DL. How to practice & teach EBM, 838Selby P, Bailey C, eds. Cancer and the adolescent, 766Shale DJ, ed. Cystic fibrosis, 527Silver T. Joint and soft tissue injection: injecting with confidence,

837Towler HM, Patterson JA, Lightman S. Diabetes and the eye, 191Walker JS, ed. Quality and safety in anaesthesia, 63Wardlaw CP et al. Stroke. A practical guide to management, 766

Bowel tumours, Caecal adenocarcinoma with multiple synchronoussmall intestinal adenocarcinoma, 729

Brachial artery puncture, False aneurysm with median nerve palsyafter iatrogenic brachial artery puncture, 43

Brachial plexus, A flaccid arm, 673Brain abscess

Gingivitis, facial weakness and focal seizures, 327Ring-enhancing lesions on computed tomography, 355

Brainstem glioma, Dysphagia, dysarthria and falls in an elderlyman, 321

Breast, Male breast tuberculosis, 428Breast carcinoma, Headache, vomiting and diplopia, 357Brodie's abscess, Symmetrical Brodie's abscess, 660Bronchial tumour

Adrenocorticotropin-secreting carcinoid tumour identified andtreated 12 years after presentation with Cushing's syndrome, 737

Ectopic acromegaly, 349A complication of a long-standing solitary lung cyst, 595Penile gangrene in lung cancer, 589

Bronchsocopy, Direct injection of anti-cancer drugs into endobron-chial tumours for palliation of major airway obstruction,159

Burr hole irrigation, Dementia in a diabetic man, 379

CCabergoline, Effects of cabergoline in a pituitary adenoma secreting

follicle-stimulating hormone, 507Caecal adenocarcinoma, Caecal adenocarcinoma with multiple

synchronous small intestinal adenocarcinoma, 729Calcification

Calcification in a gastric neoplasm, 51Multiple bony swellings and joint stiffness, 341Recurrent dehydration in a young girl, 367

Calf pain, The assessment of acute calf pain, 86Callus, A flaccid arm, 673Cannabis, Cannabis and alcohol in stroke: letter, 448Captopril therapy, Low-grade fever after prosthetic valve insertion

and captopril therapy: an iatrogenic cause, 764Carbimazole, Carbimazole-resistant thyrotoxicosis: letter, 686Carbon monoxide poisoningCarbon monoxide poisoning: letter, 189Occult CO poisoning presenting as epileptic fit: letter, 448

Carcinoid tumourAn unusual rectal polyp, 313Carcinoid tumours, 207: letter, 836Epigastric pain and left upper quadrant mass in an elderly woman,

827Facial flushes and diarrhoea, 337Octreotide scanning for carcinoid tumours, 399

Cardiac calcification, Asymptomatic murmurs, 597Cardiac centre, Setting up a heart emergency centre, 794Cardiac failure, Severe refractory congestive cardiac failure in an

elderly man, 315Cardiac leiomyosarcoma, Systemic embolisation, 115Cardiac pacing, Permanent cardiac pacing in elderly patients with

recurrent falls, dizziness and syncope, and a hypersensitivecardioinhibitory reflex, 415

Cardiac tamponade, Cardiac tamponade, 141Cardiopulmonary resuscitation, Cardiopulmonary resuscitation:

letter, 62Cardiovascular disease, Nitric oxide and cardiovascular disease,

630Carotid artery, Cerebrovascular accident in a 77-year-old man, 251Carotid-body tumour, A vascular mass in the neck, 753Carotid sinus syndrome, The overlap between syncope and falls in

the elderly, 635Castleman's disease, Pelvic mass in 46-year-old man, 371Catheters, Retrieval of intravascular iatrogenic foreign bodies using a

nonsurgical technique, 664Cell migration, The role of cell migration and microchimerism in

the induction of tolerance after solid organ transplantation,146

Central venous cannulation, Shoulder pain and pyrexia followingsubclavian line insertion, 119

Cerebellar damage, Cerebellar degeneration following neurolepticmalignant syndrome, 735

Cerebral infarction, Causes of ischaemic stroke in the young, 8Cerebral oedema, Coma during Salmonella typhimurium septicae-

mia, 585Cerebrovascular disease, Moyamoya disease, 549Cervical carcinoma, Abnormal chest X-ray in a patient with

carcinoma of the cervix, 671Cervical spine, Quadriplegia with cervical cord compression, 381Chemotherapy

Direct injection of anti-cancer drugs into endobronchial tumoursfor palliation of major airway obstruction, 159

Haemopoietic growth factors, 215

844

Subject index

Children, Advanced colonic carcinoma in children, 169Chinese, Sudden weakness in a young Chinese man, 829Chlorine gas, Inhalation of chlorine gas, 6972-Chlorodeoxyadenosine, Skin lesions in a patient with hairy cell

leukaemia, 375Cholecystectomy, Abnormal abdominal CT scan following chole-

cystectomy, 587Choreo-athetoid movements, Abnormal movements associated

with severe hyponatraemia, 503Chromosomal instability, Aplastic anaemia and reticulated skin

hyperpigmentation, 679Chronic hepatitis, A patient with Graves' disease, thrombocytopenia

and chronic hepatitis B, 39Chronic obstructive airways disease, Respiratory arrest during

dipyridamole stress testing, 301Chronic pancreatitis

Chronic pancreatitis and pancreatic carcinoma, 543Missed curable carcinoma of the pancreas presenting as chronic

pancreatitis, 577Churg-Strauss syndrome, Acute fulminant neuropathy in a patient

with Churg-Strauss syndrome, 236Cirrhosis, Abdominal pain in a cirrhotic patient with ascites, 751Clavicular fracture, A flaccid arm, 673Clinical audit, Improving management of duodenal ulcer disease,

717Clubbing, Hippocratic fingers in Behcet's disease, 575Coagulase-negative staphylococci, Fever and 'negative' blood

cultures in an elderly woman, 383Coital emergencies, Coital emergencies: letter, 525Coital trauma, Coital trauma: letter, 190Colonic cancer (carcinoma)Advanced colonic carcinoma in children, 169Bacteraemia and intestinal obstruction in a 74-year-old man, 377Carcinoma of the sigmoid colon presenting as a scrotal swelling, 47

Colonic perforation, Crohn's disease presenting with acute colonicperforation, 645

Colonoscopy, An unusual cause of 'pain in the neck', 745Colorectal adenocarcinoma, Malakoplakia and colorectal adeno-

carcinoma, 171Compartment syndrome, A complication of self-poisoning, 113Compliance, Supervised drug administration in patients with

refractory hypertension unmasking noncompliance, 239Congestive heart failure, The management of congestive heart

failure, 194: letters, 836Conotruncal cardiac defect, Velocardiofacial syndrome, 771Consultant training

Consultants' study leave - value for money? 32Warwickshire consultants' 'Training the trainers' course, 35

Continuing medical education, Continuing education for medicalprofessionals: a reflective model, 23

Continuing professional development, Continuing education formedical professionals: a reflective model, 23

Corneal opacities, Fabry's disease: a multidisciplinary disorder, 710Coronary artery disease

Exercise electrocardiogram and single vessel coronary arterydisease, 655

Genes and the development of vascular disease, 271Corticosteroid, Corticosteroid therapy in Riedel's thyroiditis, 817Corynebacterium sp, Spontaneous bacterial peritonitis due to

Corynebacterium sp: letter, 319Cough, Cough, chest pain and rash, 821Cranial neuropathy, Cranial neuropathy, 441Creatine kinase, Elevated levels of serum creatine kinase induced by

hyponatraemia, 511Creutzfeldt-Jakob disease, Creutzfeldt-Jakob disease in the elderly,

557Crohn's disease

Crohn's disease presenting with acute colonic perforation, 645Prognosis and management of Crohn's disease in the over-55 age

group, 225Crush syndrome, A complication of self-poisoning, 113Cryptosporidiosis, Cryptosporidiosis in persons with HIV infection,

713Cushing's syndrome

Adrenocorticotropin-secreting carcinoid tumour identified andtreated 12 years after presentation with Cushing's syndrome,737

Diagnostic difficulties in periodic Cushing's syndrome, 426Cyanides, Delayed cyanide poisoning following acetonitrile inges-

tion, 299Cyanotic congenital heart disease, More than an ankle sprain, 601

Cys282Tyr mutation, Rapid diagnosis of asymptomatic hereditaryhaemochromatosis by detection of the Cys282Tyr mutation inthe HIA-H gene, 573

Cytopenia, Haemopoietic growth factors, 215Cytostatic therapy, Direct injection of anti-cancer drugs into

endobronchial tumours for palliation of major airway obstruc-tion, 159

DDeep venous thrombosis, Right atrial thrombus from deep venous

thrombosis, 639Dehydration

Dehydration in the terminally ill - iatrogenic insult or naturalprocess? 476

Recurrent dehydration in a young girl, 367Delirium, Prostatic meningeal carcinomatosis presenting as delirium

tremens, 810Dementia, Hyperthyroidism and dementia, 755Deoxypyridoxine, Pyridoxine deficiency: new approaches in im-

munosuppression and chemotherapy, 617Dermatomyositis, Skin rash in a jaundiced patient, 677Desmoid tumour, Mesenteric mass in a 28-year-old woman, 121Diabetes insipidus, Recurrent dehydration in a young girl, 367Diabetes mellitusDocument of diabetes care for residential and nursing homes,

611Ketoacidosis and normal glucose tolerance, 743Painless stress fractures in diabetic neuropathic feet, 241Shoulder pain and pyrexia following subclavian line insertion, 119Six-year follow-up study of smoking habits and microvascular

complications in young adults with type 1 diabetes, 293Diagnostic imaging, Haematuria, 129Diaphragm disease, Nonsteroidal anti-inflammatory drug asso-

ciated diaphragm disease, 505Diaphragmatic hernia, An unusual cause of large bowel obstruc-

tion, 309Diarrhoea

Facial flushes and diarrhoea, 337Octreotide therapy for diarrhoea: letter, 62

Diazoxide, Diazoxide treatment for insulinoma: a national UKsurvey, 640

Diclofenac, Nonsteroidal anti-inflammatory drug associated dia-phragm disease, 505

DiGeorge anomaly, Velocardiofacial syndrome, 771Digital clubbing, Hippocratic fingers in Behret's disease, 575Dilated cardiomyopathy, Shoulder pain and pyrexia following

subclavian line insertion, 119Dipyridamole, Respiratory arrest during dipyridamole stress testing,

301Disc herniation, Paraplegia due to thoracic disc hemiation, 423Disseminated intravascular coagulationComplete gastric outlet obstruction following acid ingestion

complicated by acute pancreatitis and disseminated intravascu-lar coagulation, 421

Penile gangrene in lung cancer, 589Rash in an elderly woman presenting with collapse, 175

Diuretic, Abnormal movements associated with severe hyponatrae-mia, 503

Diverticulitis, Perforated diverticulitis following extra-abdominalsurgery, 739

Dose-response relationships, A double-blind, multicentre, place-bo-controlled study oftiludronate in Paget's disease ofbone, 496

Down's syndrome, More than an ankle sprain, 601Drug abuse, An acutely painful leg, 359Drug history, Obtaining the correct drug history: letter, 255Drug-induced agranulocytosis, Thyrotoxicosis and antithyroid

drugs, 335Drug-induced akathisia, The syndrome of motor restlessness - a

treatable but under-recognised disorder: editorial, 529Duodenal ulcer disease, Improving management of duodenal ulcer

disease, 717Dysarthria, Dysphagia, dysarthria and falls in an elderly man,

321Dyskeratosis congenita, Aplastic anaemia and reticulated skin

hyperpigmentation, 679Dyskinetic movements, Abnormal movements associated with

severe hyponatraemia, 503Dyspepsia, Management of young dyspeptic patients in the

community: editorial, 689Dysphagia, Dysphagia, dysarthria and falls in an elderly man, 321Dyspnoea, Breathlessness and a widened mediastinum, 183

845

Subject index

EEating disordersA case of plastikophagia, 243Diffuse soft tissue emphysema as a complication of anorexia

nervosa, 662Echinococcosis, Retroperitoneal cystic mass, 185Echocardiography, Severe refractory congestive cardiac failure in an

elderly man, 315EcstasyAcute hyponatraemia, 443Hyponatraemia at a rave, 53

Ectopic ACTH syndrome, Adrenocorticotropin-secreting carcinoidtumour identified and treated 12 years after presentation withCushing's syndrome, 737

EducationAcceptability of personal learning plans in vocational training, 289Consultants' study leave - value for money? 32Handbooks, learning contracts, and senior house officers: a

collaborative enterprise, 395Information technology in medical education: current and future

applications, 701Learning contracts in higher professional training: a user's guide,

279Problem-based learning and its implications for medical education

in the UK, report of a workshop held June 1996, London, 449The journal club, 81: letter, 687Views of medical students and junior doctors on pre-graduate

clinical teaching, 723Warwickshire consultants' 'Training the trainers' course, 35

ElderlyAvoidable attendance at Accident and Emergency by the elderly in

Hong Kong, 167Creutzfeldt-Jakob disease in the elderly, 557Heart failure in the elderly: letter, 189Overlap between syncope and falls in the elderly, 635Permanent cardiac pacing in elderly patients with recurrent falls,

dizziness and syncope, and a hypersensitive cardioinhibitoryreflex, 415

Use of over-the-counter medication by elderly medical in-patients,720

Using audit to improve senior house officer training, 798Embolisation, Solitary ileocolic arteriovenous malformation: Spon-

gostan and silk therapeutic embolisation, 295Emergency blood test, Emergency blood test guidelines: letter, 62Emergency centre, Setting up a heart emergency centre, 794Empyema necessitatis, Pulmonary infiltrates and skin lesions, 245Encephalopathy, Coma during Salmonella typhimurium septicaemia,

585Endobronchial tumour

Direct injection of anti-cancer drugs into endobronchial tumoursfor palliation of major airway obstruction, 159

Endobronchial inflammatory pseudotumour exacerbating asthma,98

EndocarditisBacteraemia and intestinal obstruction in a 74-year-old man, 377Endocarditis caused by Lactobacillus: letter, 61Fever and a rash, 329

Endoclip migration, Shortness of breath and jaundice, 759EndoscopyComplete gastric outlet obstruction following acid ingestion

complicated by acute pancreatitis and disseminated intravascu-lar coagulation, 421

Vomiting and weight loss, 247Eosinophilic pneumonitis, Pneumonitis induced by sulphasalazine,

99Epidermoid carcinoma, Association of sarcoidosis, low-grade B-

lymphoma and epidermoid carcinoma, 580Epileptic fit, Occult CO poisoning presenting as epileptic fit: letter,

448Epstein-Barr virus

Cranial and peripheral neuropathy due to Epstein-Barr virusinfection, 419

Retrocardiac shadow in an immunocompromised patient, 331Erectile dysfunction, The andropause: fact or fiction? 553Erythropoietin, Does erythropoietin accelerate malignant transfor-

mation in multiple myeloma?, 163Essential tremor, Hereditary essential tremor and restless legs

syndrome: letter, 254Ethmoid sinus, Ptosis in an elderly man, 55Euthyroid sick syndrome, Selenium-induced thyroid dysfunction,

103

Exercise electrocardiogram, Exercise electrocardiogram and singlevessel coronary artery disease, 655

Extrahepatic biliary obstruction, The Mirizzi syndrome, 487Eyelid neoplasm, An eyelid swelling with a parotid mass, 123

FFabry's disease, Fabry's disease: a multidisciplinary disorder, 710Falls, The overlap between syncope and falls in the elderly, 635False aneurysm, False aneurysm with median nerve palsy after

iatrogenic brachial artery puncture, 43Fasciotomy, A complication of self-poisoning, 113Fatigue, Familial chronic fatigue, 311Femoral embolisation, Systemic embolisation, 115Fever, Meningismus, fever and macular rash as presenting features of

the primary antiphospholipid syndrome? 815Fine-needle aspiration cytology, Management options for solitary

thyroid nodules in an endemic goitrous area, 560Flushes, Facial flushes and diarrhoea, 337Follicle-stimulating hormone, Effects of cabergoline in a pituitary

adenoma secreting follicle-stimulating hormone, 507Foreign bodies, Retrieval of intravascular iatrogenic foreign bodies

using a nonsurgical technique, 664Fractured ribs, Cough, chest pain and rash, 821

GGallstones, Abnormal abdominal CT scan following cholecystect-

omy, 587Gas inhalation, Inhalation of chlorine gas, 697Gastrectomy complication, An unusual late complication of gastric

surgery, 363Gastric bezoar, An unusual late complication of gastric surgery, 363Gastric leiomyoblastoma, Calcification in a gastric neoplasm, 51Gastric neoplasm, Calcification in a gastric neoplasm, 51Gastric outlet obstruction, Complete gastric outlet obstruction

following acid ingestion complicated by acute pancreatitis anddisseminated intravascular coagulation, 421

Gastritis, Vomiting and weight loss, 247Gastrointestinal disorders, Gastrointestinal disorders in Parkin-

son's disease: letter, 686Generic prescribing, Generic inhaled salbutamol versus branded

salbutamol. A randomised double-blind study, 156Genetic predisposition, Genetic predisposition of ischaemic heart

disease: letter, 188GeneticsGenes and the development of vascular disease, 271Haemophilia, 201

Geriatric medicine, Using audit to improve senior house officertraining, 798

Germ cell tumours, Testicular carcinoma, 481Giant cell tumour, Chest X-ray mass, 339Glomerulonephritis

Significance of arterial hypertension at the onset of clinical lupusnephritis, 230

Simple urine testing could avoid delay in the diagnosis of rapidlyprogressive glomerulonephritis, 808

Glucose-6-phosphate dehydrogenase, Oxidative haemolysis afterspiramycin: letter, 686

Goggles, Ocular purpura in a swimmer, 819Goitrous areas, Management options for solitary thyroid nodules in

an endemic goitrous area, 560Granulomatous disease, Vomiting and weight loss, 247Graves' disease

Hypercalcaemia, 59Patient with Graves' disease, thrombocytopenia and chronic

hepatitis B, 39Group B streptococcal meningitis, Group B streptococcal

meningitis in an adult: letter, 188Growth hormone, Ectopic acromegaly, 349Guidewires, Retrieval of intravascular iatrogenic foreign bodies using

a nonsurgical technique, 664Guillain-Barre syndromeAbdominal pain associated with cranial nerve palsy and peripheral

neuropathy, 305Acute fulminant neuropathy in a patient with Churg-Strauss

syndrome, 236

HHaemachromatosis, Hookworms to treat haemachromatosis? letter,

254Haemangioblastoma, A vascular mass in the neck, 753Haematoma, Dementia in a diabetic man, 379

846

Subject index

HaematuriaAbdominal mass and haematuria, 517Haematuria, 129

HaemochromatosisFamilial chronic fatigue, 311Rapid diagnosis of asymptomatic hereditary haemochromatosis by

detection of the Cys282Tyr mutation in the HLA-H gene,573

Haemophagocytosis, Typhoid fever with severe pancytopenia, 41Haemophilia, Haemophilia, 201Haemophilus aphrophilus, Constitutional syndrome and lumbar

pain, 599Haemopoietic growth factors, Haemopoietic growth factors, 215Hairy cell leukaemia, Skin lesions in a patient with hairy cell

leukaemia, 375Hartmann's procedure, Perforated diverticulitis following extra-

abdominal surgery, 739Head and neck cancer, Tumour seeding following percutaneous

endoscopic gastrostomy placement in head and neck cancer,430

Headaches, What's in a name? The classification of commonheadaches: editorial, 193

Heart diseaseHRT and heart disease: editorial, 465Regression of cardiac involvement by malignant melanoma follow-

ing lomustine chemotherapy, 571Heart emergency centre, Setting up a heart emergency centre, 794Heart failure

Heart failure in the elderly: letter, 189Use of angiotensin-converting enzyme inhibitors in the treatment of

heart failure in hospital practice, 409Heart transplantation, A retrocardiac shadow in an immunocom-

promised patient, 331Helicobacter pyloriImproving management of duodenal ulcer disease, 717Management of young dyspeptic patients in the community:

editorial, 689Regression of a large gastric MALT lymphoma with antibiotic

treatment to eradicate Helicobacter pylori, 109Hemichorea, Improvement of hemichorea with ondansetron: letter,

127Hemithorax, Opaque hemithorax in a young adult, 681Henoch Schoenlein purpura, Small bowel obstruction in an adult,

333Heparin

Heparin-induced thrombosis, 684Hospital-acquired hyperkalaemia, 433

Hepatitis BA patient with Graves' disease, thrombocytopenia and chronic

hepatitis B, 39Hepatitis B vaccine and neurotoxicity, 462Sudden weakness in a young Chinese man, 829

Hepatocellular carcinoma, Severe refractory congestive cardiacfailure in an elderly man, 315

Heroin, Acute abdominal pain in a young man, 667Herpes simplex encephalitis, Acute visual disturbance in a young

adult, 307Hippocratic fingers, Hippocratic fingers in Behqet's disease, 575Histiocytosis X, Langerhans cell histiocytosis (histiocytosis X),

391Histoplasmosis, Diffuse histoplasmosis in a patient with sarcoidosis,

101HIVAn HIV view of the human condition: editorial, 609Coma during Salmonella typhimurium septicaemia, 585Cryptosporidiosis in persons with HIV infection, 713Medical, social, sexual, financial and ethical problems with AIDS -

a case history, 521; commentary, 522Ophthalmic complications of HIV/AIDS: letter, 448Primary infection by type 1 human immunodeficiency virus:

diagnosis and prognosis, 403Homocystinuria, Hyperhomocysteinaemia: letter, 606Hookworms, Hookworms to treat haemachromatosis? letter, 254Hormone replacement therapy, HRT and heart disease: editorial,

465Hydatid cyst, Retroperitoneal cystic mass, 185Hydatid disease, Quadriplegia with cervical cord compression, 381Hypercalcaemia

Hypercalcaemia, 59Hyperthyroidism and dementia, 755Multiple bony swellings and joint stiffness, 341

Hyperemesis gravidarum, Unsuspected thyrotoxicosis and hyper-emesis gravidarum in Asian women, 234

Hyperhomocysteinaemia, Hyperhomocysteinaemia: letter, 606Hyperkalaemia, Hospital-acquired hyperkalaemia, 433HyperlipidaemiaHigh fever and high lipids, 365Post-transplant hyperlipidaemia, 785

HypernatraemiaHypematraemia, 57Recurrent dehydration in a young girl, 367

HyperparathyroidismHypercalcaemia, 59Hyperthyroidism and dementia, 755Treatment of vitamin D deficient osteomalacia may unmask

autonomous hyperparathyroidism, 813Hyperpyrexia, Cerebellar degeneration following neuroleptic malig-

nant syndrome, 735Hypersensitive cardioinihibitory reflex, Permanent cardiac pa-

cing in elderly patients with recurrent falls, dizziness andsyncope, and a hypersensitive cardioinhibitory reflex, 415

HypertensionNitric oxide and cardiovascular disease, 630Significance of arterial hypertension at the onset of clinical lupus

nephritis, 230Supervised drug administration in patients with refractory hyper-

tension unmasking noncompliance, 239Hyperthyroidism, Paralysis after treatment for thyrotoxicosis, 445Hypertrophic osteoarthropathy, More than an ankle sprain, 601Hypoaldosteronism, Hospital-acquired hyperkalaemia, 433Hypoglycaemia

Diazoxide treatment for insulinoma: a national UK survey, 640Hyponatraemia and spontaneous hypoglycaemia, 675

Hypogonadism, Thrombophilia in a man with long-standinghypogonadism, 761

HypokalaemiaParalysis after treatment for thyrotoxicosis, 445Self-induced myopathy, 593

HyponatraemiaAbnormal movements associated with severe hyponatraemia, 503Acute hyponatraemia, 443Elevated levels of serum creatine kinase induced by hyponatraemia,

511Hyponatraemia at a rave, 53Hyponatraemia and spontaneous hypoglycaemia, 675

Hypopituitarism, Hypopituitarism due to lymphocytic hypophysitisin a patient with retroperitoneal fibrosis, 732

HypothyroidismHypothyroidism presenting as acute abdomen, 373Selenium-induced thyroid dysfunction, 103

IIbuprofen, Nonsteroidal anti-inflammatory drug associated dia-

phragm disease, 505Ileal perforation, Multiple ileal perforations, 757Ileocolic artery, Solitary ileocolic arteriovenous malformation:

Spongostan and silk therapeutic embolisation, 295Iloprost, An acutely painful leg, 359ImmunosuppressionMaintenance pharmacological immunosuppressive strategies in

renal transplantation, 386Pyridoxine deficiency: new approaches in immunosuppression and

chemotherapy, 617Retrocardiac shadow in an immunocompromised patient, 331Severe pneumococcal disease and temporary splenic dysfunction,

173Inferior vena cava, Abdominal retroperitoneal lymphadenopathy in

an elderly man, 591Inflammatory pseudotumour, Endobronchial inflammatory pseu-

dotumour exacerbating asthma, 98Information technology, Information technology in medical educa-

tion: current and future applications, 701Insulin-dependent diabetes, A six-year follow-up study of smoking

habits and microvascular complications in young adults withtype 1 diabetes, 293

Insulinoma, Diazoxide treatment for insulinoma: a national UKsurvey, 640

Interferon-alphaBipolar disorder associated with interferon-alpha treatment, 834Rapid neurological deterioration in a 22-year-old man, 344

Internet, Information technology in medical education: current andfuture applications, 701

847

Subject index

Interstitial nephritis, Interstitial nephritis, 151Intestinal angina, Chronic abdominal pain, 831Intestinal obstruction

Small bowel obstruction in an adult, 333Superior mesenteric artery syndrome, 776

Intra-arterial injection, An acutely painful leg, 359Intracerebral haemorrhage, Mental dullness after thrombolytic

therapy, 347Intracranial calcification, Recurrent dehydration in a young girl,

367Intraperitoneal free gas, Spontaneous pneumoperitoneum and

other nonsurgical causes of intraperitoneal free gas, 531Iodine deficiency, Selenium-induced thyroid dysfunction, 103Iron accumulation, Rapid diagnosis of asymptomatic hereditary

haemochromatosis by detection of the Cys282Tyr mutation inthe HLA-H gene, 573

Irritable bowel syndrome, The irritable bowel syndrome, 1Ischaemic colitis, Mesenteric revascularisation for acute-on-chronic

intestinal ischaemia, 642Ischaemic heart disease, Genetic predisposition of ischaemic heart

disease: letter, 188Ischaemic stroke, Causes of ischaemic stroke in the young, 8Isoprinosine, Rapid neurological deterioration in a 22-year-old man,

344Isotope scanning, Facial flushes and diarrhoea, 337

JJejunal mass, Epigastric pain and left upper quadrant mass in an

elderly woman, 827Journal club, The journal club, 81: letter, 687Junior doctors, The views of medical students and junior doctors on

pre-graduate clinical teaching, 723

KKetoacidosis, Ketoacidosis and normal glucose tolerance, 743Kidney, Abdominal mass and haematuria, 517Klebsiella pneumoniae, Tropical liver abscess, 89Klinefelter's syndrome, Thrombophilia in a man with long-

standing hypogonadism, 761Knee, A painful knee in an immunocompromised patient, 49

LLactobacillus, Endocarditis caused by Lactobacillus: letter, 61Langerhans cell histiocytosis, Langerhans cell histiocytosis (histio-

cytosis X), 391Laparoscopic cholecystectomy, Shortness of breath and jaundice,

759Laser photoablation, An unusual cause of 'pain in the neck', 745Laurence-Moon-Biedl syndrome, Polydactyly and partial blind-

ness, 747Learning

Acceptability of personal learning plans in vocational training, 289Handbooks, learning contracts, and senior house officers: a

collaborative enterprise, 395Learning contracts in higher professional training: a user's guide,

279Leiomyoblastoma, Calcification in a gastric neoplasm, 51Leiomyosarcoma, Systemic embolisation, 115Leprosy, Late reversal reaction after 10 years of adequately treated

leprosy, 741Leuprolide, Prostatic meningeal carcinomatosis presenting as delir-

ium tremens, 810Lipid-lowering drugs, Post-transplant hyperlipidaemia, 785Lipoma, Excess adipose and heartburn, 369Liposarcoma, Splenomegaly, 125Liquorice, Self-induced myopathy, 593Liver abscess, Tropical liver abscess, 89Liver disease, Ursodeoxycholic acid in the treatment of liver

diseases, 75Lomustine, Regression of cardiac involvement by malignant mela-

noma following lomustine chemotherapy, 571Losartan, Reversible acute renal failure induced by losartan in a renal

transplant recipient, 105Low-grade fever, Low-grade fever after prosthetic valve insertion

and captopril therapy: an iatrogenic cause, 764Low molecular weight heparin, Anticoagulants for venous

thrombosis, 283: letter, 687Lung cyst, A complication of a long-standing solitary lung cyst,

595Lupus nephritis, The significance of arterial hypertension at the

onset of clinical lupus nephritis, 230

Lymphadenopathy, Abdominal retroperitoneal lymphadenopathy inan elderly man, 591

Lymphangitis carcinomatosis, Abnormal chest X-ray in a patientwith carcinoma of the cervix, 671

Lymphocytic hypophysitis, Hypopituitarism due to lymphocytichypophysitis in a patient with retroperitoneal fibrosis, 732

LymphomaAssociation of sarcoidosis, low-grade B-lymphoma and epidermoid

carcinoma, 580Facial swelling in a patient with sarcoidosis, 181Photosensitivity and lymphoma, 435Retrocardiac shadow in an immunocompromised patient, 331

MMagnetic resonance imaging

Cranial neuropathy, 441Dementia in a diabetic man, 379Paraplegia due to thoracic disc herniation, 423

Malakoplakia, Malakoplakia and colorectal adenocarcinoma, 171Malaria, Presentation of Plasmodium vivax malaria: letter, 607Malignancy, The role of ultrasound in the diagnosis of a large,

rapidly growing, thyroid mass, 412Malignant melanoma, Regression of cardiac involvement by

malignant melanoma following lomustine chemotherapy, 571Malignant transformationDoes erythropoietin accelerate malignant transformation in multi-

ple myeloma? 163Malignant change in a chronic skin lesion induced by an

intravenous cannula, 45MALT tumour, Regression of a large gastric MALT lymphoma with

antibiotic treatment to eradicate Helicobacter pylori, 109Marfan syndrome, Large airway obstruction by a chronic dissecting

aortic aneurysm in the Marfan syndrome, 726Median nerve palsy, False aneurysm with median nerve palsy after

iatrogenic brachial artery puncture, 43Medical anniversaries

Berlioz, Hector, 11 December 1803, 801Bernard, Claude, 12 July 1813, 408Clover, Joseph Thomas, 28 February 1825, 88Fleming, Sir Alexander, 6 August 1881, 490Freud, Sigmund, 6 May 1856, 304Gee, Samuel, 13 September 1839, 559Hall, Reginald, 1 October 1931, 644Lettsom, John Coakley, 22 November 1744, 716Price, William, 4 March 1800, 155Sims, James Marion, 25 January 1813, 38Welch, William H, 8 April 1850, 224

Meibomian carcinoma, An eyelid swelling with a parotid mass,123

Membranous glomerulonephritis, Treatment of progressive renalfailure and nephrotic syndrome with azathioprine and predni-solone, 647

Meningeal carcinomatosis, Prostatic meningeal carcinomatosispresenting as delirium tremens, 810

Meningismus, Meningismus, fever and macular rash as presentingfeatures of the primary antiphospholipid syndrome? 815

MeningitisGroup B streptococcal meningitis in an adult: letter, 188Pneumococcal vaccine, 222

Meningo-encephalitis, A treatable cause of lymphocytic meningo-encephalitis, 437

Meningococcal septicaeniia, Fever and a rash, 329Mesenteric angiography, Chronic abdominal pain, 831Mesenteric fibromatosis, Mesenteric mass in a 28-year-old woman,

121Mesenteric revascularisation, Mesenteric revascularisation for

acute-on-chronic intestinal ischaemia, 642Metachronous primary sarcomas, Splenomegaly, 125Metastases

Renal cell carcinoma with solitary metastases appearing during 18years of follow-up, 582

Tumour seeding following percutaneous endoscopic gastrostomyplacement in head and neck cancer, 430

Metastatic heart disease, Regression of cardiac involvement bymalignant melanoma following lomustine chemotherapy, 571

Methimazole-induced agranulocytosis, Thyrotoxicosis and an-tithyroid drugs, 335

Methotrexate pneumonitis, Methotrexate pneumonitis in a patientwith rheumatoid arthritis, 603

Methyl cyanide, Delayed cyanide poisoning following acetonitrileingestion, 299

848

Subject index

Micro-angiopathic haemolytic anaemia, An unusual cause ofchest pain, 825

Microchimerism, The role of cell migration and microchimerism inthe induction of tolerance after solid organ transplantation,146

Midazolam, Arrhythmia in a 38-year-old man, 249Mirizzi syndrome, The Mirizzi syndrome, 487Mitral valve, Fever and 'negative' blood cultures in an elderly

woman, 383Molecular biology, Common terms in molecular biology - part 1 (a-

f), 317: part 2 (g-p), 460: part 3 (r-z), 523Motor restlessness, The syndrome ofmotor restlessness - a treatable

but under-recognised disorder: editorial, 529Moyamoya disease, Moyamoya disease, 549Mucosa-associated lymphoid tissue, Regression of a large gastric

MALT lymphoma with antibiotic treatment to eradicateHelicobacter pylori, 109

Multi-drug therapy, Late reversal reaction after 10 years ofadequately treated leprosy, 741

Multimedia, Information technology in medical education: currentand future applications, 701

Multiple myelomaCranial neuropathy, 441Does erythropoietin accelerate malignant transformation in multi-

ple myeloma?, 163Mutism, Cerebellar degeneration following neuroleptic malignant

syndrome, 735Myasthenia gravis, Lethargy in a patient with cirrhosis, 177Mycobacterium kansasii, Skin lesions in a patient with hairy cell

leukaemia, 375Mycobacterium tuberculosis

Tropical liver abscess, 89Unusual pulmonary mass, 323

Mycosis fungoides, A rapidly enlarging keratinised 'skull-cap', 111Myocardiac infarction, Mental dullness after thrombolytic therapy,

347Myocardial infarctionGenes and the development of vascular disease, 271Minimising delays to thrombolysis in patients developing acute

myocardial infarction in hospital, 491Unusual neurological problem in a patient admitted for acute

myocardial infarction, 669Myocarditis, Sudden death in Whipple's disease, 509Myopathy, Self-induced myopathy, 593Myositis ossificans progressiva, Multiple bony swellings and joint

stiffness, 341

NNail-patella syndrome, Proteinuria in a young man, 361Native valve, Fever and 'negative' blood cultures in an elderly

woman, 383NeckA vascular mass in the neck, 753An unusual cause of 'pain in the neck', 745

Nephrectomy, Renal cell carcinoma with solitary metastasesappearing during 18 years of follow-up, 582

Nephritis, Interstitial nephritis, 151Nephrogenic diabetes insipidus, Recurrent dehydration in a young

girl, 367Neuralgia, The management of postherpetic neuralgia, 623Neuroectodermal tumour, Mass on chest X-ray, 515Neuroendocrine tumours, Carcinoid tumours, 207: letter, 839Neurofibromatosis, Abdominal mass in a 19-year-old with neurofi-

bromatosis, 325Neuroleptic malignant syndrome

Cerebellar degeneration following neuroleptic malignant syndrome,735

Neuroleptic malignant syndrome in the acquired immunodefi-ciency syndrome, 779

NeuropathyAcute fulminant neuropathy in a patient with Churg-Strauss

syndrome, 236Cranial neuropathy, 441Cranial and peripheral neuropathy due to Epstein-Barr virus

infection, 419Painless stress fractures in diabetic neuropathic feet, 241

Neurotoxicity, Hepatitis B vaccine and neurotoxicity, 462Neutrophilic dermatoses, Neutrophilic dermatoses: pyoderma

gangrenosum and Sweet's syndrome, 65Nitrates, Post-prandial syncope due to nitrates in food: letter, 606Nitric oxide, Nitric oxide and cardiovascular disease, 630

Nitrofurantoin, Nitrofurantoin rechallenge and recurrent toxicity,519

Nocardia asteroides, Gingivitis, facial weakness and focal seizures,327

Nonbacterial thrombotic endocarditis, Penile gangrene in lungcancer, 589

Non-Hodgkin's lymphoma, Facial swelling in a patient withsarcoidosis, 181

Nonsteroidal anti-inflammatory drugsInterstitial nephritis, 151Nonsteroidal anti-inflammatory drug associated diaphragm disease,

505Nurse, Expanding the role of the nurse in the Accident and

Emergency department, 17Nursing homes, Document of diabetes care for residential and

nursing homes, 611

0Occlusion, Cerebrovascular accident in a 77-year-old man, 251Occult primary, Carcinoma of the sigmoid colon presenting as a

scrotal swelling, 47Octreotide

Carcinoid tumours, 207: letter, 839Ectopic acromegaly, 349Octreotide scanning for carcinoid tumours, 399Octreotide therapy for diarrhoea: letter, 62

Ocular damage, Ocular purpura in a swimmer, 819Oesophagus, Boerhaave's syndrome, 265Ondansetron, Improvement of hemichorea with ondansetron: letter,

127Onycho-osteodysplasia, Proteinuria in a young man, 361Ophthalmic complications, Ophthalmic complications of HIV/

AIDS: letter, 448Ophthalmoplegia, Ptosis in an elderly man, 55Ossification, Multiple bony swellings and joint stiffness, 341Osteitis deformans., A double-blind, multicentre, placebo-con-

trolled study of tiludronate in Paget's disease of bone, 496Osteomalacia, Treatment of vitamin D deficient osteomalacia may

unmask autonomous hyperparathyroidism, 813Osteomyelitis

Shoulder pain and pyrexia following subclavian line insertion, 119Symmetrical Brodie's abscess, 660

Outcome measure, Quality of life as an outcome measure, 613Over-the-counter medications, The use of over-the-counter

medication by elderly medical in-patients, 720Oxidative haemolysis, Oxidative haemolysis after spiramycin: letter,

686

pPaediatrics, The journal club, 81: letter, 687Paget's disease

Double-blind, multicentre, placebo-controlled study of tiludronatein Paget's disease of bone, 496

Paget's disease of bone, 69Pain, The management of postherpetic neuralgia, 623Pancreatectomy, Pancreatic adenocarcinoma: why and when should

it be resected? 469Pancreatic adenocarcinoma, Pancreatic adenocarcinoma: why and

when should it be resected? 469Pancreatic cancer (carcinoma)

Chronic pancreatitis and pancreatic carcinoma, 543Missed curable carcinoma of the pancreas presenting as chronic

pancreatitis, 577Skin rash in a jaundiced patient, 677

PancreatitisAcute abdomen after total hip replacement, 351Chronic pancreatitis and pancreatic carcinoma, 543Complete gastric outlet obstruction following acid ingestion

complicated by acute pancreatitis and disseminated intravascu-lar coagulation, 421

High fever and high lipids, 365Missed curable carcinoma of the pancreas presenting as chronic

pancreatitis, 577Pancytopenia, Typhoid fever with severe pancytopenia, 41Paracentesis, Abdominal pain in a cirrhotic patient with ascites, 751Paracetamol, Potentiation of the anticoagulant effect of warfarin,

439Paraganglioma, An intra-abdominal tumour, 353Paralysis, Paralysis after treatment for thyrotoxicosis, 445Paralytic ileus, Hypothyroidism presenting as acute abdomen, 373Paraneoplastic syndrome, Skin rash in a jaundiced patient, 677

849

Subject index

Paraplegia, Paraplegia due to thoracic disc herniation, 423Parasites

Parasite infection in an officer of an ocean liner, 749The protozoan view of the human condition: editorial, 769

Parkinson's diseaseGastrointestinal disorders in Parkinson's disease: letter, 686Parkinson's disease, 257

Parotid neoplasm, An eyelid swelling with a parotid mass, 123Pelvic mass, Pelvic mass in 46-year-old man, 371Penicilamnine, Lethargy in a patient with cirrhosis, 177PenisAn unusual lesion of the penis, 179Incarceration of the penis by a metallic ring: letter, 255

Percutaneous endoscopic gastrostomy, Tumour seeding follow-ing percutaneous endoscopic gastrostomy placement in headand neck cancer, 430

Perforation, Perforated diverticulitis following extra-abdominalsurgery, 739

Pericardiocentesis, Cardiac tamponade, 141PeritonitisBarium peritonitis: a rare complication of upper gastrointestinal

contrast investigation, 297Spontaneous bacterial peritonitis due to Corynebacterium sp: letter,

319Personal learning plan, The acceptability of personal learning plans

in vocational training, 289Phaeochromocytoma, A vascular mass in the neck, 753Photosensitivity, Photosensitivity and lymphoma, 435Pica, A case of plastikophagia, 243Pilonidal cyst, An unusual lesion of the penis, 179Pituitary adenoma, Effects of cabergoline in a pituitary adenoma

secreting follicle-stimulating hormone, 507Pituitary apoplexyHeadache, vomiting and diplopia, 357Unusual neurological problem in a patient admitted for acute

myocardial infarction, 669Pituitary metastases, Headache, vomiting and diplopia, 357Pituitary tumour, Cerebrovascular accident in a 77-year-old man,

251Plasma cell granuloma, Endobronchial inflammatory pseudotu-

mour exacerbating asthma, 98Plasmodium vivax malaria, Presentation of Plasmodium vivax

malaria: letter, 607Plastikophagia, A case of plastikophagia, 243Pleural effusion, Pleuritic pain and fever, 117Pneumococcal disease, Severe pneumococcal disease and tempor-

ary splenic dysfunction, 173Pneumoconiosis, Pneumoconiosis, 513Pneumomediastinum, Spontaneous pneumoperitoneum and other

nonsurgical causes of intraperitoneal free gas, 531Pneumonia, Pneumococcal vaccine, 222Pneumonitis

Methotrexate pneumonitis in a patient with rheumatoid arthritis,603

Pneumonitis induced by sulphasalazine, 99Pneumoperitoneum, Spontaneous pneumoperitoneum and other

nonsurgical causes of intraperitoneal free gas, 531Pneumothorax

Spontaneous contralateral pneumothorax following pneumonect-omy, 107

Spontaneous pneumoperitoneum and other nonsurgical causes ofintraperitoneal free gas, 531

PoisoningCarbon monoxide poisoning: letter, 189Delayed cyanide poisoning following acetonitrile ingestion, 299Occult CO poisoning presenting as epileptic fit: letter, 448

Polydactyly, Polydactyly and partial blindness, 747Polyethylene glycol, Sudden death in Whipple's disease, 509Polymerase chain reactionAcute visual disturbance in a young adult, 307Rapid diagnosis of asymptomatic hereditary haemochromatosis by

detection of the Cys282Tyr mutation in the HLA-H gene, 573Polyneuropathy, Abdominal pain associated with cranial nerve palsy

and peripheral neuropathy, 305Porphyria cutanea tarda, Photosensitivity and lymphoma, 435Post-prandial syncope, Post-prandial syncope due to nitrates,in

food: letter, 606Postherpetic neuralgia, The management of postherpetic neuralgia,

623Postoperative acute pancreatitis, Acute abdomen after total hip

replacement, 351

Praziquantel, Parasite infection in an officer of an ocean liner, 749Prednisolone, Treatment of progressive renal failure and nephrotic

syndrome with azathioprine and prednisolone, 647Prions, Creutzfeldt-Jakob disease in the elderly, 557Problem-based learning, Report of a workshop on problem-based

learning and its implications for medical education in the UK,June 1996, London, 449

Prognosis, Primary infection by type 1 human immunodeficiencyvirus: diagnosis and prognosis, 403

Prostate cancerAndropause: fact or fiction? 553Localised carcinoma of the prostate: a paradigm of uncertainty, 691

Prostatic neoplasms, Prostatic meningeal carcinomatosis presentingas delirium tremens, 810

Prosthetic valve insertion, Low-grade fever after prosthetic valveinsertion and captopril therapy: an iatrogenic cause, 764

Protozoa, The protozoan view of the human condition: editorial,769

Pseudoaneurysm, Peripheral arterial pseudoaneurysm treated byultrasound-guided compression, 651

Pseudohermaphroditism, Male pseudohermaphroditism due to5alpha-reductase-2 deficiency in an Arab kindred, 802

Psoas abscess, Constitutional syndrome and lumbar pain, 599Psychiatry, Psychiatry in trauma care: letter, 190Psychogenic adipsia, Hypernatraemia, 57Ptosis, Ptosis in an elderly man, 55Public health medicine, Continuing education for medical profes-

sionals: a reflective model, 23Pulmonary agenesis, Opaque hemithorax in a young adult, 681Pulmonary artery compression, Breathlessness and a widened

mediastinum, 183Pulmonary embolism, Thrombophilia in a man with long-standing

hypogonadism, 761Pulmonary mass, An unusual pulmonary mass, 323Pulmonary metastasis, Chest X-ray mass, 339Pulmonary tuberculosis, An unusual pulmonary mass, 323Purpura, Ocular purpura in a swimmer, 819Pyoderma gangrenosum, Neutrophilic dermatoses: pyoderma

gangrenosum and Sweet's syndrome, 65Pyridoxine deficiency, Pyridoxine deficiency: new approaches in

immunosuppression and chemotherapy, 617

QQuadriplegia, Quadriplegia with cervical cord compression, 381Quality of life, Quality of life as an outcome measure, 613

RRadionuclide imaging, Octreotide scanning for carcinoid tumours,

399Rave, Hyponatraemia at a rave, 53Reactive airways dysfunction syndrome, Inhalation of chlorine

gas, 697Rectal bleeding, Massive arterial bleeding from a single rectal vessel,

303Rectal neoplasm, An unusual rectal polyp, 313Rectal perforation, An unusual cause of 'pain in the neck', 745Registrars, The acceptability of personal learning plans in vocational

training, 289Renal cell carcinoma, Renal cell carcinoma with solitary metastases

appearing during 18 years of follow-up, 582Renal failure

Interstitial nephritis, 151Reversible acute renal failure induced by losartan in a renal

transplant recipient, 105Treatment of progressive renal failure and nephrotic syndrome with

azathioprine and prednisolone, 647Renal transplantation, Maintenance pharmacological immunosup-

pressive strategies in renal transplantation, 386Residential homes, Document of diabetes care for residential and

nursing homes, 611Respiratory arrest, Respiratory arrest during dipyridamole stress

testing, 301Respiratory disease, Inhalation of chlorine gas, 697Restless legs syndrome

Hereditary essential tremor and restless legs syndrome: letter, 254Syndrome of motor restlessness - a treatable but under-recognised

disorder: editorial, 529Retinal dystrophy, Polydactyly and partial blindness, 747Retinal necrosis, Acute visual disturbance in a young adult, 307Retrocardiac mass, A retrocardiac shadow in an immunocompro-

mised patient, 331

850

Subject index

Retroperitoneal abscess, Abnormal abdominal CT scan followingcholecystectomy, 587

Retroperitoneal fibrosisHypopituitarism due to lymphocytic hypophysitis in a patient with

retroperitoneal fibrosis, 732Tamoxifen for retroperitoneal fibrosis, 653

Retroperitoneal lymphangioma, Abdominal mass and haematuria,517

Retroperitoneal tumour, Excess adipose and heartburn, 369Revascularisation, Mesenteric revascularisation for acute-on-chronic

intestinal ischaemia, 642Rheumatoid arthritis

Methotrexate pneumonitis in a patient with rheumatoid arthritis,603

Pneumonitis induced by sulphasalazine, 99Rib fractures, Cough, chest pain and rash, 821Riedel's thyroiditis, Corticosteroid therapy in Riedel's thyroiditis,

817

SSalbutamol, Generic inhaled salbutamol versus branded salbutamol.

A randomised double-blind study, 156Salivary gland hypofunction, Signs and symptoms in patients with

salivary gland hypofunction, 93Salmonella typhimurium, Coma during Salmonella typhimurium

septicaemia, 585Sarcoidosis

Diffuse histoplasmosis in a patient with sarcoidosis, 101Facial swelling in a patient with sarcoidosis, 181

Sarcoidosis-lymphoma syndrome, Association of sarcoidosis, low-grade B-lymphoma and epidermoid carcinoma, 580

Sarcoma, Soft tissue tumours, 705Scrofula, Pulmonary infiltrates and skin lesions, 245Scrotal swelling, Carcinoma of the sigmoid colon presenting as a

scrotal swelling, 47Selenium, Selenium-induced thyroid dysfunction, 103Self-poisoning, A complication of self-poisoning, 113Sellar metastases, Headache, vomiting and diplopia, 357Senior house officer trainingHandbooks, learning contracts, and senior house officers: a

collaborative enterprise, 395Using audit to improve senior house officer training, 798

Septicaemia, Coma during Salmonella typhimurium septicaemia,585

Serine hydroxymethyltransferase, Pyridoxine deficiency: newapproaches in immunosuppression and chemotherapy, 617

Shingles, A treatable cause of lymphocytic meningo-encephalitis, 437Sicca syndrome, Lethargy in a patient with cirrhosis, 177Sickness Impact Profile, Quality of life as an outcome measure, 613Sigmoid colon, Carcinoma of the sigmoid colon presenting as a

scrotal swelling, 47Silicosis, Pneumoconiosis, 513Silk, Solitary ileocolic arteriovenous malformation: Spongostan and

silk therapeutic embolisation, 295Sinus of Valsalva, Asymptomatic murmurs, 597Sixth nerve palsy, Cranial neuropathy, 441Sjogren's syndrome, Signs and symptoms in patients with salivary

gland hypofunction, 93Skin cancer, Basal cell carcinoma, 538Skin lesion, Malignant change in a chronic skin lesion induced by an

intravenous cannula, 45Skin rash, Meningismus, fever and macular rash as presenting

features of the primary antiphospholipid syndrome? 815'Skull-cap', A rapidly enlarging keratinised 'skull-cap', 111Smoking, A six-year follow-up study of smoking habits and micro-

vascular complications in young adults with type 1 diabetes, 293Sodium, Elevated levels of serum creatine kinase induced by

hyponatraemia, 511Soft tissue emphysema, Diffuse soft tissue emphysema as a

complication of anorexia nervosa, 662Soft tissue tumour, Soft tissue tumours, 705Somatostatin analogues, Carcinoid tumours, 207: letter, 839Spinal cord compression

Paraplegia due to thoracic disc hemiation, 423Quadriplegia with cervical cord compression, 381

Spinal epidural haemorrhage, Spontaneous spinal epidural hae-morrhage complicating transjugular intrahepatic portosystemicstent shunting, 649

Spinal tuberculosis, Spinal tuberculosis: letter, 525Spiramycin, Oxidative haemolysis after spiramycin: letter, 686Spleen, Splenomegaly, 125

Splenic dysfunction, Severe pneumococcal disease and temporarysplenic dysfunction, 173

Spongostan, Solitary ileocolic arteriovenous malformation: Spongo-stan and silk therapeutic embolisation, 295

Spontaneous contralateral pneumothorax, Spontaneous contral-ateral pneumothorax following pneumonectomy, 107

Spontaneous oesophageal perforation, Boerhaave's syndrome, 265Staphylococcus aureus, Fever and a rash, 329Status epilepticus, Thyroid storm presenting as status epilepticus

and stroke: letter, 61Streptococcal meningitis, Group B streptococcal meningitis in an

adult: letter, 188Streptococcus pneumoniae, Pneumococcal vaccine, 222Streptococcus sanguis bacteraemia, Bacteraemia and intestinal

obstruction in a 74-year-old man, 377Stress fractures, Painless stress fractures in diabetic neuropathic feet,

241Stress testing

Respiratory arrest during dipyridamole stress testing, 301Stroke complicating adenosine perfusion imaging, 659

StrokeCannabis and alcohol in stroke: letter, 448Causes of ischaemic stroke in the young, 8Cerebrovascular accident in a 77-year-old man, 251Stroke complicating adenosine perfusion imaging, 659Thyroid storm presenting as status epilepticus and stroke: letter, 61

Study leaveConsultants' study leave - value for money? 32Warwickshire consultants' 'Training the trainers' course, 35

Subacute sclerosing panencephalitis, Rapid neurological deteriora-tion in a 22-year-old man, 344

Subdural haematoma, Dementia in a diabetic man, 379Subphrenic abscess, Shortness of breath and jaundice, 759Sulphasalazine, Pneumonitis induced by sulphasalazine, 99Superior mesenteric artery syndrome

Gastric outlet obstruction - with a difference, 823Superior mesenteric artery syndrome, 776

Superior vena cava obstruction, Facial swelling in a patient withsarcoidosis, 181

Sweet's syndrome, Neutrophilic dermatoses: pyoderma gangreno-sum and Sweet's syndrome, 65

Swimming, Ocular purpura in a swimmer, 819Syncope

Overlap between syncope and falls in the elderly, 635Permanent cardiac pacing in elderly patients with recurrent falls,

dizziness and syncope, and a hypersensitive cardioinhibitoryreflex, 415

Post-prandial syncope due to nitrates in food: letter, 606Syndrome of inappropriate antidiuresis, Acute hyponatraemia,

443Systemic lupus erythematosus, The significance of arterial hyper-

tension at the onset of clinical lupus nephritis, 230

TTaenia saginata, Parasite infection in an officer of an ocean liner,

749Talcosis, Pneumoconiosis, 513Tamoxifen, Tamoxifen for retroperitoneal fibrosis, 653Teaching methods, The views of medical students and junior doctors

on pre-graduate clinical teaching, 723Temazepam, An acutely painful leg, 359Tension pneumothorax, An unusual cause of large bowel obstruc-

tion, 309Terminal illness, Dehydration in the terminally ill - iatrogenic insult

or natural process? 476Testicular cancer, Testicular carcinoma, 481Testicular metastasis, Carcinoma of the sigmoid colon presenting as

a scrotal swelling, 47Testosterone supplements, The andropause: fact or fiction?

553Thiamine deficiency, Wernicke-Korsakoff syndrome, 27Thoracic aortic aneurysms, Breathlessness and a widened medias-

tinum, 183Thrombocytopenia, A patient with Graves' disease, thrombocytope-

nia and chronic hepatitis B, 39ThrombolysisMental dullness after thrombolytic therapy, 347Minimising delays to thrombolysis in patients developing acute

myocardial infarction in hospital, 491Thrombophilia, Thrombophilia in a man with long-standing

hypogonadism, 761

851

Subject index

ThrombosisAssessment of acute calf pain, 86Heparin-induced thrombosis, 684Meningismus, fever and macular rash as presenting features of the

primary antiphospholipid syndrome? 815Thrombotic thrombocytopenic purpura, An unusual cause of

chest pain, 825Thymic carcinoid, Diagnostic difficulties in periodic Cushing's

syndrome, 426Thyroid mass, The role of ultrasound in the diagnosis of a large,

rapidly growing, thyroid mass, 412Thyroid neoplasms, Management options for solitary thyroid

nodules in an endemic goitrous area, 560Thyroid storm, Thyroid storm presenting as status epilepticus and

stroke: letter, 61Thyrotoxic periodic paralysis, Sudden weakness in a young

Chinese man, 829Thyrotoxicosis

Carbimazole-resistant thyrotoxicosis: letter, 686Lethargy in a patient with cirrhosis, 177Paralysis after treatment for thyrotoxicosis, 445Patient with Graves' disease, thrombocytopenia and chronic

hepatitis B, 39Unsuspected thyrotoxicosis and hyperemesis gravidarum in Asian

women, 234Tibia, Symmetrical Brodie's abscess, 660Tiludronate, A double-blind, multicentre, placebo-controlled study

of tiludronate in Paget's disease of bone, 496Torsade de pointes, Arrhythmia in a 38-year-old man, 249Tracheal compression, Corticosteroid therapy in Riedel's thyroidi-

tis, 817Training

Acceptability of personal learning plans in vocational training, 289Consultants' study leave - value for money? 32Handbooks, learning contracts, and senior house officers: a

collaborative enterprise, 395Learning contracts in higher professional training: a user's guide,

279Using audit to improve senior house officer training, 798Warwickshire consultants' 'Training the trainers' course, 35

Transjugular intrahepatic portosystemic stent shunting, Spon-taneous spinal epidural haemorrhage complicating transjugularintrahepatic portosystemic stent shunting, 649

Transoesophageal echocardiographyBacteraemia and intestinal obstruction in a 74-year-old man, 377Regression of cardiac involvement by malignant melanoma following

lomustine chemotherapy, 571Transoesophageal echocardiography, 137

TransplantationPost-transplant hyperlipidaemia, 785Reversible acute renal failure induced by losartan in a renal

transplant recipient, 105Role of cell migration and microchimerism in the induction of

tolerance after solid organ transplantation, 146Trauma

Coital emergencies: letter, 525Coital trauma: letter, 190Psychiatry in trauma care: letter, 190

Tremor, Hereditary essential tremor and restless legs syndrome: letter,254

TuberculosisMale breast tuberculosis, 428Prevalence of Addison's disease in Coventry, UK, 286Pulmonary infiltrates and skin lesions, 245Ring-enhancing lesions on computed tomography, 355Spinal tuberculosis: letter, 525

Unusual pulmonary mass, 323Vomiting and weight loss, 247

Tuberculous perforation, Multiple ileal perforations, 757Typhoid fever, Typhoid fever with severe pancytopenia, 41

UUltra-large von Willebrand multimers, An unusual cause of chest

pain, 825UltrasoundAssessment of acute calf pain, 86Peripheral arterial pseudoaneurysm treated by ultrasound-guided

compression, 651Role of ultrasound in the diagnosis of a large, rapidly growing,

thyroid mass, 412Ultraviolet radiation, Basal cell carcinoma, 538Umbilical hernia, Abdominal pain in a cirrhotic patient with ascites,

751Upper gastrointestinal contrast investigation, Barium peritonitis:

a rare complication of upper gastrointestinal contrast investiga-tion, 297

Urine testing, Simple urine testing could avoid delay in the diagnosisof rapidly progressive glomerulonephritis, 808

Uroporphyrin decarboxylase, Photosensitivity and lymphoma, 435Ursodeoxycholic acid, Ursodeoxycholic acid in the treatment of liver

diseases, 75

VVaccination, Pneumococcal vaccine, 222Valsartan, Drug-induced antisynthetase syndrome, 165Varicella-zoster virus, A treatable cause of lymphocytic meningo-

encephalitis, 437Vascular malformation, An intra-abdominal tumour, 353Velocardiofacial syndrome, Velocardiofacial syndrome, 771Venous cannula puncture, Malignant change in a chronic skin lesion

induced by an intravenous cannula, 45Venous thromboembolism, Anticoagulants for venous thrombosis,

283: letter, 687Vitamin D, Treatment of vitamin D deficient osteomalacia may

unmask autonomous hyperparathyroidism, 813Von Hippel-Lindau disease, A vascular mass ian the neck, 753von Recklinghausen's disease, Abdominal mass in a 19-year-old

with neurofibromatosis, 325

WWarfarin

Potentiation of the anticoagulant effect of warfarin, 439Warfarin potentiation with bezafibrate, 657Treatmnent of 'warfarin intolerance': letter, 607

Water intoxication, Hyponatraemia at a rave, 53Wegener's granulomatosis, Simple urine testing could avoid delay

in the diagnosis of rapidly progressive glomerulonephritis, 808Wernicke-Korsakoff syndrome, Wemicke-Korsakoff syndrome, 27Whipple's disease, Sudden death in Whipple's disease, 509World wide web, 690

xXanthogranulomatous pyelonephritis, Pleuritic pain and fever, 117Xerostomia, Signs and symptoms in patients with salivary gland

hypofunction, 93

yYellow nail syndrome, Yellow nail syndrome, 466Young adult

Causes of ischaemic stroke in the young, 8Six-year follow-up study of smoking habits and microvascular

complications in young adults with type 1 diabetes, 293

852

Postgrad Med _J 1997; 73: 853- 864 (C The Fellowship of Postgraduate Medicine, 1997

VOLUME 73. CONTENTS

No 855, January 1997

No 856, February 1997

Page Review articlesClassic diseases revisited

1 The irritable bowel syndrome.CY Francis, 1P WhorwellClinical guidelines

8 Causes of ischaemic stroke in the young.P1 Martin, TP Enevoldson, PRD HumphreyDeveloping the role of the nurse specialist

17 Expanding the role of the nurse in the Accident and Emergency department.BL NeadesTechniques in medical education

23 Continuing education for medical professionals: a reflective model.S Brigley, Y Young, P Littleohns, J McEwenEponyms in medicine revisited

27 Wemicke-Korsakoff syndrome.C Zubaran, JG Fernandes, R RodnightOriginal articles

32 Consultants' study leave -value for money?J7R Bennett

35 Warwickshire consultants' 'Training the trainers' course.A Whitehouse

38 Medical anniversaryShort reports

39 A patient with Graves' disease, thrombocytopenia and chronic hepatitis B.CC Szeto, CC Chow, GTC Ko, KY Li, VTF Yeung, CS Cockram

41 Typhoid fever with severe pancytopenia.R Sood, S Roy, P Kaushik

43 False aneurysm with median nerve palsy after iatrogenic brachial artery puncture.KMH Yip, H Yurianto, J Lin

45 Malignant change in a chronic skin lesion induced by an intravenous cannula.UU Nkere, A Banjar

47 Carcinoma of the sigmoid colon presenting as a scrotal swelling.NP Bryan, A J7ackson, AT RafterySelf-assessment corner

49 A painful knee in an immunocompromised patient.RM Pattison, MA O'Donnell, R Powles, ALH Moss

51 Calcification in a gastric neoplasm.M Garcia-Diaz, MVAzuara, I Narv&ez, M Alcalde, R Moro, J Saenz de Santamaria

53 Hyponatraemia at a rave.SA Box, LF Prescott, S Freestone

55 Ptosis in an elderly man.SW Yusuf, RM Mishra

57 Hypernatraemia.M Hagley, C Egleston, M Goddard, D Rowlands, J Franklin

59 Hypercalcaemia.S Vijayaraghavan, A Jones, DF Wood, J7P MonsonLetters to the Editor

61 Thyroid storm presenting as status epilepticus and strokeEndocarditis caused by LactobacillusEmergency blood test guidelinesCardiopulmonary resuscitationOctreotide therapy for diarrhoea

63 Book Reviews64 International Postgraduate Diary

Page Review articlesEponyms in medicine revisited

65 Neutrophilic dermatoses: pyoderma gangrenosum and Sweet's syndrome.J'T Lear, MTAtherton, JPH ByrneClassic diseases revisited

69 Paget's disease of bone.CG Ooi, WD FraserNew therapies

75 Ursodeoxycholic acid in the treatment of liver diseases.S Saksena, RK Tandon

854 Contents to volume 73

Techniques in medical education81 The journal club.

RP Valentini, SR DanielsClinical guidelines

86 The assessment of acute calf pain.A Banerlee

88 Medical anniversary

Original articles89 Tropical liver abscess.

KG Yeoh, I Yap, ST Wong, A Wee, R Guan, JY Kang93 Signs and symptoms in patients with salivary gland hypofunction.

LP Longman, SM Higham, R Bucknall, SB Kaye, WM Edgar, EA Field

Short reports98 Endobronchial inflammatory pseudotumour exacerbating asthma.

D Jayne, B Bridgewater, RAM Lawson99 Pneumonitis induced by sulphasalazine.

FPJ Peters, LG7B Engels, AMJ Moers101 Diffuse histoplasmosis in a patient with sarcoidosis.

PS Badesha, MG Saklayen, N HiUman103 Selenium-induced thyroid dysfunction.

LC Hojbauer, C Spitzweg, RA Magerstddt, AE Heufelder105 Reversible acute renal failure induced by losartan in a renal transplant recipient.

M Ostermann, DJA Goldsmith, T Doyle, JC Kingswood, P Sharpstone107 Spontaneous contralateral pneumothorax following pneumonectomy.

JGH Hubbard, UU Nkere, NK Bhatnagar109 Regression of a large gastric MALT lymphoma with antibiotic treatment to eradicate Helicobacter pylon.

J Martin, S Boyle, M JacynaSelf-assessment corner

111 A rapidly enlarging keratinised 'skull cap'.LM Samuel, LAM Matheson

113 A complication of self-poisoning.CH Gerrand, MR Reddy, MA Waldram, M Simms

115 Systemic embolisation.D Richardson, CHJones

117 Pleuritic pain and fever.JV Mendez, E Castro, M Dorao, S Pedraza

119 Shoulder pain and pyrexia following subclavian line insertion.MR Carpenter, M Vassalo, W Bourke, PI Sell, JEF Pohl, AJI Scriven

121 Mesenteric mass in a 28-year-old woman.A Gautam, AK Khatri, M Pandey, NC Arya, VK Shukla

123 An eyelid swelling with a parotid mass.V Seenu, MC Misra, RK Khazanchi, AK Goel, MB Prakash

125 Splenomegaly.H Al-Omishy, C Lockett, JA Rees, BR Davidson

Letter to the Editor127 Improvement of hemichorea with ondansetron

128 International Postgraduate Diary

No 857, March 1997 Page Review articlesClassic signs revisited

129 Haematuria.AG RockaUl, APG Newman-Sanders, MA Al-Kutoubi, JA ValeNew techniques in medicine

137 Transoesophageal echocardiography.JE Sanderson, WWM ChanMedical emergencies

141 Cardiac tamponade.JB Ball, WL MorrisonNew concepts in medicine

146 The role of cell migration and microchimerism in the induction of tolerance after solid organ transplant.RM3Jindal, A SahotaClassic diseases revisited

151 Interstitial nephritis.S Dhillon, RM Higgins

155 Medical anniversary

Original articles156 Generic inhaled salbutamol versus branded salbutamol. A randomised double-blind study.

IJ Williamson, A Reid, RDH Monie, AG Fennerty, EM Rimmer

Contents to volume 73

159 Direct injection of anti-cancer drugs into endobronchial tumours for palliation of major airway obstruction.SI (Celikoklu, T Karayel, S Demirci, F QCelikoklu, T gagatayShort reports

163 Does erythropoietin accelerate malignant transformation in multiple myeloma?A Olujohungbe, S Handa, J Holmes

165 Drug-induced antisynthetase syndrome.DR Thickett, AB MiUlar

167 Avoidable attendance at Accident and Emergency by the elderly in Hong Kong.EMC Lau, J Woo, JTS Chan

169 Advanced colonic carcinoma in children.AM Khan, CM Doig, AP Dickson

171 Malakoplakia and colorectal adenocarcinoma.AWBates, S Dev, SI Baithun

173 Severe pneumococcal disease and temporary splenic dysfunction.MDE Pelly, Z Huo, DC Henderson, N Soni

Self-assessment corner175 Rash in an elderly woman presenting with collapse.

C Prajapati, BS Phillips, MJ Bradshaw177 Lethargy in a patient with cirrhosis.

SY Chuah, NW Wong, KL Goh179 An unusual lesion of the penis.

M Saharay, A Farooqui, M Chappell181 Facial swelling in a patient with sarcoidosis.

MJ Ledson, MC Walton, CRK Hind183 Breathlessness and a widened mediastinum.

PNE Bruce-Jones, RA Meehan, SC Allen185 Retroperitoneal cystic mass.

JD Sanchez L6pez, J Alcalde, A Ibarra, P Aguado, S Rodriguez, AM Bay6n, C Morales, A Abad

186 Answers to Christmas QuizLetters to the Editor

188 Group B streptococcal meningitis in an adultGenetic predisposition of ischaemic heart diseaseCarbon monoxide poisoningHeart failure in the elderlyPsychiatry in trauma careCoital trauma

191 Book reviews

192 International Postgraduate Diary

No 858, April 1997 Page Editorial193 What's in a name? The classification of common headaches.

SJ Ellis

Review articlesClinical guidelines

194 The management of congestive heart failure.FA McAlister, KK TeoClassic diseases revisited

201 Haemophilia.MR Cahill, BT ColvinProgress in the management of solid tumours

207 Carcinoid tumours.S Janmohamed, SR BloomNew therapies

215 Haemopoietic growth factors.NJ Ketley, AC NewlandNew techniques in medicine

222 Pneumococcal vaccine.KL Hattotuwa, CRK Hind

224 Medical anniversaryOriginal articles

225 Prognosis and management of Crohn's disease in the over-55 age group.RS Walmsley, CD Gilen, RN AUlan

230 The significance of arterial hypertension at the onset of clinical lupus nephritis.IP Naiker, V Chrystal, IGH Randeree, YK SeedatShort reports

234 Unsuspected thyrotoxicosis and hyperemesis gravidarum in Asian women.W Chong, C Jrohnston

855

Contents to volume 73

236 Acute fulminant neuropathy in a patient with Churg-Strauss syndrome.KKP Ng, HM Yeung, KT Loo, HM Chan, CK Wong, PCK Li

239 Supervised drug administration in patients with refractory hypertension unmasking noncompliance.CC Cronin, TM Higgins, MB Murphy, JB Ferriss

241 Painless stress fractures in diabetic neuropathic feet.G Gill, S Benbow, S Tesfaye, E Kaczmarczyk, L Kaye

Self-assessment corner243 A case of plastikophagia.

M Battin, J Kennedy, S Singh245 Pulmonary infiltrates and skin lesions.

I Avivi, S Vulfsons, R Finkelstein, T Hayek, JG Brook247 Vomiting and weight loss.

K Vazifdar, A Nagral, S Krishnamurthy, S Nagral249 Arrhythnmia in a 38-year-old man.

TP Ip, CP Lau, KSL Lam251 Cerebrovascular accident in a 77-year-old man.

JC Garcia-Monco, A Capelastegui, MG Beldarrain, E Guerra

Letters to the Editor254 Hereditary essential tremor and restless legs syndrome

Hookworms to treat haemachromatosisObtaining the correct drug historyIncarceration of the penis by a metallic ring

256 International Postgraduate Diary

No 859, May 1997 Page Review articlesClassic diseases revisited

257 Parkinson's disease.JR PlayferEponyms in medicine revisited

265 Boerhaave's syndrome.KJJlanjuaGenetics and medicine

271 Genes and the development of vascular disease.CA Foy, pI GrantTechniques in medical education

279 Learning contracts in higher professional training: a user's guide.P Brambleby, R CoatesManagement options

283 Anticoagulants for venous thrombosis.CH Toh

Original articles286 The prevalence of Addison's disease in Coventry, UK.

AC Willis, FP Vince289 The acceptability of personal learning plans in vocational training.

AN Siriwardena293 A six-year follow-up study of smoking habits and microvascular complications in young adults with type I

diabetes.RN Sinha, AW Patrick, L Richardson, M Wallymahmed, IA MacFarlane

Short reports295 Solitary ileocolic arteriovenous malformation: Spongostan and silk therapeutic embolisation.

M Alcalde, G Jiminez, P Diaz, M Garcia-Diaz, J'M Pascasio, R Moro, J Zapata, A L6pez-Santamaria297 Barium peritonitis: a rare complication of upper gastrointestinal contrast investigation.

ID Karanikas, DD Kakoulidis, ZT Gouvas, JE Hartley, SS Koundourakis299 Delayed cyanide poisoning following acetonitrile ingestion.

M Mueller, C Borland301 Respiratory arrest during dipyridamole stress testing.

GS Hillis, A Al-Mohammad, KPJennings303 Massive arterial bleeding from a single rectal vessel.

JD Harrison, A Calatayud, VR Thava, RM Kirby

304 Medical anniversarySelf-assessment corner

305 Abdominal pain associated with cranial nerve palsy and peripheral neuropathy.LK Dawson, CD Selby, KCH Fearon, CJ Mumford, ER Chilvers

307 Acute visual disturbance in a young adult.GV McDonnell, G Silvestri, J7A Lytle, PV Coyle

309 An unusual cause of large bowel obstruction.F Mihaimeed, A Yong, T Paes

311 Familial chronic fatigue.DK George, RM Evans, IR Gunn

856

Contents to volume 73

313 An unusual rectal polyp.DS Bhandarkar, AW Caslin, MHJamison

315 Severe refractory congestive cardiac failure in an elderly man.B O'Neill, H Taggart

316 Christmas Quiz WinnersGlossary

317 Common terms in molecular biology - part 1 (a-f).JD KhandekarLetter to the Editor

319 Spontaneous bacterial peritonitis due to Corynebacterium sp

319 Book review

320 International Postgraduate Diary

No 860, June 1997 Page Self-assessment questions in medicine321 Dysphagia, dysarthria and falls in an elderly man.

B McGleenon, IC Steele, AP Passmore323 An unusual pulmonary mass.

L G6mez, R Rami-Porta, A Domingo, M Rodriguez-Carballeira, J3L Heredia325 Abdominal mass in a 19-year-old with neurofibromatosis.

I Samuel, S Jakate, MM Ramsey, 77 Saclarides327 Gingivitis, facial weakness and focal seizures.

PYC Lee, CEM Hilier, GM Viagappan329 Fever and a rash.

KJ7MJeffery, SJ Peacock331 A retrocardiac shadow in an immunocompromised patient.

FU Huwez, MJ Stewart, AR McPhaden, IS Stewart, SK Naik, D Richens, DJ Wheadey333 Small bowel obstruction in an adult.

AI Smith, J3W SerpeUl335 Thyrotoxicosis and antithyroid drugs.

D Monakier, S Shilo337 Facial flushes and diarrhoea.

V Crasset, E Delcourt339 Chest X-ray mass.

P Sundaram, J7MJoseph, B Trivedi, LP Naik, JMJoshi341 Multiple bony swellings and joint stiffness.

R Mittal, V Gupta, S Bhan344 Rapid neurological deterioration in a 22-year-old man.

MO McCarron, GVMcDonnell, J3M Gibson347 Mental dullness after thrombolytic therapy.

KS Woo, HCK Chan, WS Poon349 Ectopic acromegaly.

JK Platts, DF Child, P Meadows, J7N Harvey351 Acute abdomen after total hip replacement.

M Nashi, B Banerlee353 An intra-abdominal tumour.

A Rehm, RJ WiUliams355 Ring-enhancing lesions on computed tomography.

NS Brid, AG Kulkarni, MM Kale, PJ Shah, SR Yadav357 Headache, vomiting and diplopia.

A Cant6n, R Sim6, L Gil, A Ortega, J Mesa359 An acutely painful leg.

A Wedderburn, P Carter, G Morris361 Proteinuria in a young man.

R Handa, J3P Wali, P Aggarval363 An unusual late complication of gastric surgery.

F Calder, H Souka, R Lightwood365 High fever and high lipids.

AB Ballinger, H Lawrie, MJG Farthing367 Recurrent dehydration in a young girl.

M Zaki, EAR Ismail, HM Nadi, A Nour El Din369 Excess adipose and heartburn.

WDB Clements, P Rice, C Harvey371 Pelvic mass in a 46-year-old man.

J7 Fl6rez, G Garcia-Pardo, TAuguet, -I Sirvent, M Bel, C Richart373 Hypothyroidism presenting as acute abdomen.

N Kumar, MH Wheeler375 Skin lesions in a patient with hairy cell leukaemia.

P Raanani, M Thaler, N Keller, I Ben-Bassat377 Bacteraemia and intestinal obstruction in a 74-year-old man.

GK Davis, MJ Brack, MT Hendrickse, DH Roberts

857

Contents to volume 73

379 Dementia in a diabetic man.M Odawara, K Tada, M Asano, M Ogawa, T Nose, K Yamashita

381 Quadriplegia with cervical cord compression.A Tammam, HA Crockard

383 Fever and 'negative' blood cultures in an elderly woman.J7C Graham, N Kennedy, FJ Nye

No 861, July 1997 Page Editorial385 Adverse drug reaction of the month - a new series.

MD Rawlins, AM Breckenridge, SM Wood, PC Waller, R Coulson

Review articlesNew therapies

386 Maintenance pharmacological immunosuppressive strategies in renal transplantation.JP Vella, MH SayeghClassic diseases revisited

391 Langerhans cell histiocytosis (histiocytosis X).K-YLamTechniques in medical education

395 Handbooks, learning contracts, and senior house officers: a collaborative enterprise.G ParsellNew techniques in medicine

399 Octreotide scanning for carcinoid tumours.M CritchleyHIV medicine

403 Primary infection by type 1 human immunodeficiency virus: diagnosis and prognosis.P Vanhems, R Beaulieu

408 Medical anniversaryOriginal articles

409 The use of angiotensin-converting enzyme inhibitors in the treatment of heart failure in hospital practice.CG Missouris, GA MacGregor

412 The role of ultrasound in the diagnosis of a large, rapidly growing, thyroid mass.AD King, AT Ahuja, W King, C Metreweli

415 Permanent cardiac pacing in elderly patients with recurrent falls, dizziness and syncope, and a hypersensitivecardioinhibitory reflex.JrG Crilley, B Herd, CS Khurana, CA Appleby, AM de Belder, A Davies, JA HallShort reports

419 Cranial and peripheral neuropathy due to Epstein-Barr virus infection.C Gavin, Y Langan, M Hutchinson

421 Complete gastric outlet obstruction following acid ingestion complicated by acute pancreatitis anddisseminated intravascular coagulation.Z Ahmed, Z Moyhuddin

423 Paraplegia due to thoracic disc herniation.B Pal, A Johnson

426 Diagnostic difficulties in periodic Cushing's syndrome.AB Walker, GP Leese, J7P Vora

428 Male breast tuberculosis.C Jaideep, M Kumar, AK Khanna

430 Tumour seeding following percutaneous endoscopic gastrostomy placement in head and neck cancer.D Thorburn, SN Karim, DS Soutar, PR Mills

Self-assessment corner433 Hospital-acquired hyperkalaemia.

NCM Bacon435 Photosensitivity and lymphoma.

DP Busuttil, MG Davies, J7A Copplestone, MD Hamon, AG Prentice437 A treatable cause of lymphocytic meningio-encephalitis.

K Fox, EP Wright, JK Ramage439 Potentiation of the anticoagulant effect of warfarin.

DA Fitzmaurice, J3A Murray441 Cranial neuropathy.

OC Cockerell, R Kapoor443 Acute hyponatraemia.

ID Watson, M Serlin, P Moncur, F Tames445 Paralysis after treatment for thyrotoxicosis.

HLA Janssen, PHLM Geelhoed-Duijvestijn, AWde Weerd

Letters to the Editor448 Occult CO poisoning presenting as epileptic fit

Cannabis and alcohol in strokeOphthalmic complications of HIV/AIDS

Meeting report449 Report of a workshop on problem-based learning and its implications for medical education in the UK,

held 7 June 1996 at the Royal Society of Medicine, London

858

Contents to volume 73

Glossary460 Common terms in molecular biology - part 2 (g-p).

J3D KhandekarAdverse drug reaction of the month

462 Hepatitis B vaccine and neurotoxicity.M Pirmohamed, P Winstanley

464 International Postgraduate Diary

No 862, August 1997 Page Editorial465 HRT and heart disease.

AJ'B Brady, J7B WarrenReview articlesClassic diseases revisited

466 Yellow nail syndrome.A Hershko, B Hirshberg, M Nahir, G FriedmanDecision making in medicine

469 Pancreatic adenocarcinoma: why and when should it be resected?D Ravichandran, CD JohnsonCurrent concepts in medicine

476 Dehydration in the terminally ill: iatrogenic insult or natural process?SM Chadfield-Mohr, CM ByattProgress in the management of solid tumours

481 Testicular carcinoma.A O'Callaghan, GM MeadEponyms in medicine revisited

487 The Mirizzi syndrome.M Pemberton, AD Wells

490 Medical anniversaryOriginal articles

491 Minimising delays to thrombolysis in patients developing acute myocardial infarction in hospital.AD Mumford, AP Banning

496 A double-blind, multicentre, placebo-controlled study of tiludronate in Paget's disease of bone.WD Fraser, TC Stamp, RA Creek, J7P Sawyer, C PicotShort reports

503 Abnormal movements associated with severe hyponatraemia.N Nagaratnam, E Icao, H Peric

505 Nonsteroidal anti-inflammatory drug associated diaphragm disease.A McGonigal, DF Moffat, GBM Lindop, 17 Gilchrist

507 Effects of cabergoline in a pituitary adenoma secreting follicle-stimulating hormone.G Leese, R Jeffreys, J Vora

509 Sudden death in Whipple's disease.P McGettigan, EE Mooney, M Sinnott, EC Sweeney, J Feely

511 Elevated levels of serum creatine kinase induced by hyponatraemia.I Goldenberg, M3Jonas, M Thaler, E GrossmanSelf-assessment corner

513 Pneumoconiosis.JM Joshi, NV Kolhe, P Sundaram

515 Mass on chest X-ray.GA da Silva, JC Manco, J7T Filho, H Glass, FA Soares

517 Abdominal mass and haematuria.PM Hewitt, WY Lau, TM Mackenzie, KF To, AKC LiAdverse drug reaction of the month

519 Nitrofurantoin rechallenge and recurrent toxicity.MC Bialas, HGM Shetty, J Houghton, F Woods, PA RoutledgeSounding off

521 Medical, social, sexual, financial and ethical problems with AIDS - a case history.AnonymousGlossary

523 Common terms in molecular biology - part 3 (r-z).J7D KhandekarLetters to the Editor

525 Spinal tuberculosisCoital emergencies

526 Books received

527 Book reviews

528 International Postgraduate Diary

859

860

No 863, September 1997 Page Editorial529 The syndrome of motor restlessness - a treatable but under-recognised disorder.

AMO Bakheit

Review articlesMedical emergencies

531 Spontaneous pneumoperitoneum and other nonsurgical causes of intraperitoneal free gas.NMA Williams, DFL WatkinClassic diseases revisited

538 Basal cell carcinoma.J7T Lear, AG SmithDiagnostic dilemmas

543 Chronic pancreatitis and pancreatic carcinoma.J7D Evans, DG Morton, JP NeoptolemosEponyms in medicine revisited

549 Moyamoya disease.M Farrugia, DC Howlett, AM SaksNew diseases

553 The andropause: fact or fiction?N Burns-Cox, C GingeUlMedicine in the elderly

557 Creutzfeldt-Jakob disease in the elderly.R de Silva, C Findlay, I Awad, R Harries-Jones, R Knight, R WiU

559 Medical anniversaryOriginal articles

560 Management options for solitary thyroid nodules in an endemic goitrous area.AK Sarda, A Gupta, PKJlain, S Prasad

565 Microbiologically proven bacterial infections in AIDS.BL Kirkpatrick, SC Glover, DS Reeves, AP MacGowanShort reports

571 Regression of cardiac involvement by malignant melanoma following lomustine chemotherapy.MR Carpenter, M Vassallo, IM Peat, AJ'I Scriven

573 Rapid diagnosis of asymptomatic hereditary haemochromatosis by detection of the Cys282Tyr mutation in theHLA-H gene.S Aslam, GR Standen

575 Hippocratic fingers in Behcet's disease.M Benekli, IH Gullh

577 Missed curable carcinoma of the pancreas presenting as chronic pancreatitis.SM Wharton, Z Rahman, CD Johnson

580 Association of sarcoidosis, low-grade B-lymphoma and epidermoid carcinoma.J' Romero, S Ramon y Cajal, JtA Vargas, R Perez-Maestu, C Salas, CA Regueiro, G Aragon

582 Renal cell carcinoma with solitary metastases appearing during 18 years of follow-up.M Siekierska-HeUmann, K Sworczak, A Lewczuk, K Blaut, E BojSelf-assessment corner

585 Coma during Salmonella typhimurium septicaemia.F Leibinger, JM Guerin, A Mofredj

587 Abnormal abdominal CT scan following cholecystectomy.AEK Ibrahim, HJS Jones, J'K Derodra

589 Penile gangrene in lung cancer.Y Biyukapk, N Saytnalp, M Ancr, IC Haznedaroglu, OI Ozcebe, S Diindar

591 Abdominal retroperitoneal lymphadenopathy in an elderly man.T Hayek, A Engel, A Eyal, J'C Brook

593 Self-induced myopathy.SJS Chataway, CJ Mumford, JW Ironside

595 A complication of a longstanding solitary lung cyst.J7GH Hubbard, UU Nkere, R Azhar

597 Asymptomatic murmurs.SA Biggart, DJ Coltart

599 Constitutional syndrome and lumbar pain.C Font, C Casals, T Kaifi, E Coll, J Cid, J Villalta, J7M Grau

601 More than an ankle sprain.FJ AndrewsAdverse drug reaction of the month

603 Methotrexate pneumonitis in a patient with rheumatoid arthritis.R Clearkin, PA Corns, SHL Thomas

605 Book reviews

Letters to the Editor606 Post-prandial syncope due to nitrates in food

HyperhomocysteinaemiaTreatment of 'warfarin intolerance'Plasmodium vivax malaria

608 International Postgraduate Diary

Contents to volume 73

Contents to volume 73

No 864, October 1997 Page Editorial609 An HIV view of the human condition.

PD WelsbyReview articlesClinical guidelines

611 Document of diabetes care for residential and nursing homes.AJ Sinclair, CJ Turnbull, SCM CroxsonCurrent concepts in medicine

613 Quality of life as an outcome measure.CJ BulpittNew therapies

617 Pyridoxine deficiency: new approaches in immunosuppression and chemotherapy.A Trakatellis, A Dimitriadou, M TrakatelliClassic diseases revisited

623 The management of postherpetic neuralgia.D BowsherNew concepts in medicine

630 Nitric oxide and cardiovascular disease.M McIntyre, AF DominiczakMedicine in the elderly

635 The overlap between syncope and falls in the elderly.FE Shaw, RA Kenny

639 Images in clinical medicine

Original articles640 Diazoxide treatment for insulinoma: a national UK survey.

GV Gill, 0 Rauf, IA MacFarlane642 Mesenteric revascularisation for acute-on-chronic intestinal ischaemia.

RJ Holdsworth, Z Raza, S Naidu, PT McCollum

644 Medical anniversaryShort reports

645 Crohn's disease presenting with acute colonic perforation.MK Roy, RJ Delicata, PD Carey

647 Treatment of progressive renal failure and nephrotic syndrome with azathioprine and prednisolone.LRI Baker, B Tucker, IC Macdougall, R Oommen

649 Spontaneous spinal epidural haemorrhage complicating transjugular intrahepatic portosystemic stentshunting.S McLellan, R de Silva, PA Sandercock, PC Hayes, J Dillon, D Redhead

651 Peripheral arterial pseudoaneurysm treated by ultrasound-guided compression.Y-C Cheung, Y-L Wan

653 Tamoxifen for retroperitoneal fibrosis.L Frankart, F Lorge, J Donckier

655 Exercise electrocardiogram and single vessel coronary artery disease.A Chauhan, SI Thuraisingham, DL Stone

657 Warfarin potentiation with bezafibrate.TRO Beringer

659 Stroke complicating adenosine perfusion imaging.IA Khan, SA Samual

660 Symmetrical Brodie's abscess.AFW Chambler, PJ Chapman-Sheath, MF Pearse, J Hollingdale

662 Diffuse soft tissue emphysema as a complication ofanorexia nervosa.AI Hatzitolios, ML Sion,AD Kounanis, EN Toulis, A Dimitriadis, I Ioannidis, GNZiakias

664 Retrieval of intravascular iatrogenic foreign bodies using a nonsurgical technique.L Martin, K Strahan, G Murphy

Self-assessment corner667 Acute abdominal pain in a young man.

HM Al-Attia, M Al Murawy, A Hareb, OB Gatee669 An unusual neurological problem in a patient admitted for acute myocardial infarction.

AD Kelion, M Shahi, JA Bell671 Abnormal chest X-ray in a patient with carcinoma of the cervix.

PAggarwval, R Handa, JP Wali, N Wig, A Kumar673 A flaccid arm.

K Raza, P King675 Hyponatraemia and spontaneous hypoglycaemia.

OMPJolobe, TS Htin677 Skin rash in a jaundiced patient.

M Akasheh, K Omari, F Madanat679 Aplastic anaemia and reticulated skin hyperpigmentation.

H Demiroglu, M Alikafifojiu, B Yalfin, S Diindar681 Opaque hemithorax in a young adult.

R Guleria, A Mohan, S Mukhopadhyay

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Contents to volume 73

Adverse drug reaction of the month684 Heparin-induced thrombosis.

NJL Gittoes, JT Wilde, MC Sheppard, RE Femer

685 Books received

Letters to the Editor686 Carbimazole-resistant thyrotoxicosis

Gastrointestinal disorders in Parkinson's diseaseOxidative haemolysis after spiramycinThe journal clubAnticoagulants for venous thrombosis

688 International Postgraduate Diary

No 865, November 1997 Page Editorial689 Management of young dyspeptic patients in the community.

TCK Tham

Review articlesManagement options

691 Localised carcinoma of the prostate: a paradigm of uncertainty.SS Sandhu, AV KaisaryMedical emergencies

697 Inhalation of chlorine gas.JG WiUiamsTechniques in medical education

701 Information technology in medical education: current and future applications.GA Mooney, JG BlighProgress in the management of solid tumours

705 Soft tissue tumours.AJ Hayes, JM ThomasEponyms in medicine revisited

710 Fabry's disease: a multidisciplinary disorder.FPJ Peters, A Sommer, A Vermeulen, EC Cheriex, TL KhoHIV medicine

713 Cryptosporidosis in persons with HIV infection.B Ramratnam, TP Flanigan

716 Medical anniversaryClinical audit

717 Improving management of duodenal ulcer disease.MC Bateson, BL DiffeyOriginal articles

720 The use of over-the-counter medication by elderly medical in-patients.GM Batty, CA Oborne, CG Swift, SHD Jackson

723 The views of medical students and junior doctors on pre-graduate clinical teaching.B Ward, G Moody, JF MayberryShort reports

726 Large airway obstruction by a chronic dissecting aortic aneurysm in the Marfan syndrome.MR Hargreaves, 773 Gilbert, R Pillai, G Hart

729 Caecal adenocarcinoma with multiple synchronous small intestinal adenocarcinoma.J Lee, R Tamhane, TG Parks

732 Hypopituitarism due to lymphocytic hypophysitis in a patient with retroperitoneal fibrosis.A Alvarez, F Cordido, F Sacristan

735 Cerebellar degeneration following neuroleptic malignant syndrome.V Lal, V Sardana, A Thussu, IMS Sawhney, S Prabhakar

737 Adenocorticotropin-secreting carcinoid tumour identified and treated 12 years after presentation withCushing's syndrome.B Vaidya, D Richardson, cJ Hilton, P Kendall-Taylor

739 Perforated diverticulitis following extra-abdominal surgery.AM Gaya, EM Chisholm, HJ Scott, DR Donaldson

741 Late reversal reaction after 10 years of adequately treated leprosy.AK Thacker, P Kumar, RD Mukhija, SP SharmaSelf-assessment corner

743 Ketoacidosis and normal glucose tolerance.K McKenna, J Doig, CJ Thompson

745 An unusual cause of 'pain in the neck'.S Manjunath, DB Trash

747 Polydactyly and partial blindness.VRR Kodali

749 Parasite infection in an officer of an ocean liner.H Kato, M Shirotani, M Enoki, K Oogushi, S Emura, T Takashima, K Ohmori

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Contents to volume 73

751 Abdominal pain in a cirrhotic patient with ascites.I Touze, T Asselah, A Boruchowicz, J'-C Paris

753 A vascular mass in the neck.R Eliashar, J'-Y Sichel, D Saah, I Braverman

755 Hyperthyroidism and dementia.M Dennis, SG Parker

757 Multiple ileal perforations.N Chitkara, P Garg, RN Tehlan, V Dheer

759 Shortness of breath and jaundice.J7AD Stewart, MC Gunn, BJr Rathbone, GSM Robertson

761 Thrombophilia in a man with long-standing hypogonadism.LR Ranganath, L Jrones, AG Lim, SR Gould, PF Goddard

Adverse drug reaction of the month764 Low-grade fever after prosthetic valve insertion and captopril therapy: an iatrogenic cause.

MC Bialas, H Varley, HGM Shetty, PA Routledge766 Book reviews

768 International Postgraduate Diary

No 866, December 1997 Page Editorial769 The protozoan view of the human condition.

DH Molyneux

Review articlesGenetics and medicine

771 Velocardiofacial syndrome.AC Pike, M SuperClassic diseases revisited

776 Superior mesenteric artery syndrome.AR Ahmed, I TaylorHIV medicine

779 Neuroleptic malignant syndrome in the acquired immunodeficiency syndrome.J7L Hernindez, L Palacios-Araus, S Echevarnia, A Herrdn, J7F Campo, JA RianchoTransplantation medicine

785 Post-transplant hyperlipidaemia.RM JindalSetting up new medical services

794 Setting up a heart emergency centre.SJS Virk, E Edmunds, RA Perry

797 An appreciation - Professor Bill Whimster

Clinical audit798 Using audit to improve senior house officer training.

A J7ohansen

801 Medical anniversary

Original articles802 Male pseudohermaphroditism due to 5a-reductase-2 deficiency in an Arab kindred.

HM Al-Attia808 Simple urine testing could avoid delay in the diagnosis of rapidly progressive glomerulonephritis.

M Howse, J MainShort reports

810 Prostatic meningeal carcinomatosis presenting as delirium tremens.JB Rubins, MJ Guzman-Paz

813 Treatment of vitamin D deficient osteomalacia may unmask autonomous hyperparathyroidism.AVG Taylor, PH Wise

815 Meningismus, fever and macular rash as presenting features of the primary antiphospholidpid syndrome?T Houghton, AG Davies

817 Corticosteroid therapy in Riedel's thyroiditis.B Vaidya, PE Harris, P Barrett, P Kendall-Taylor

819 Ocular purpura in a swimmer.NI Jowett, SG JowettSelf-assessment corner

821 Cough, chest pain and rash.Z Ahmed, HM Al-Attia, Z Mohyuddin

823 Gastric outlet obstruction.D Clarke, AK Sharma, K Shute

825 An unusual cause of chest pain.SA Brown, S Popat, R Carr

827 Epigastric pain and a left upper quadrant mass in an elderly woman.R Joarder, AC Hanris, M Gibson, A Al-Kutoubi

829 Sudden weakness in a young Chinese man.IVRR Kodali, B j7effcote, RB Clague

863

864 Contents to volume 73

831 Chronic abdominal pain.DR Parker, S Evans, JGC Kingham

Adverse drug reaction of the month834 Bipolar disorder associated with interferon-alpha treatment.

I Iancu, A Sverdlik, PN Dannon, E Lepkifker

Letters to the Editor836 Carcinoid tumours

Management of congestive heart failure

837 Book reviews

839 International Postgraduate Diary

840 Author index

843 Subject index

853 Contents to volume 73

Postgraduate Medical JournalINSTRUCTIONS TO AUTHORSThe aims of the Postgraduate Medical Journal are three-fold. Firstly, to help doctors in training to acquire the necessary skills toenable them to deliver the highest possible standards of patient care. Secondly, to help the trainers to develop suitable trainingprogrammes for their trainees. Finally, once that training is completed, to allow these doctors to maintain those high standards bya process of continuing medical education.To achieve these aims we publish original papers, short reports and commissioned editorials and review articles. We are alsodelighted to receive unsolicited editorials and reviews, from doctors and others. The Postgraduate MedicalJoumnal peer reviews allthe material it receives. Other items may include Self-assessment questions, Letters to the Editor, Book reviews and anInternational postgraduate diary. The full proceedings of meetings may be published as supplements to the Journal. ThePostgraduate Medical Journal is published monthly in the English language, and has an international readership.

TypescriptsThree complete copies should be sent to the Editor, PostgraduateMedical journal, 12 Chandos Street, London WlM 9DE, UK. Papersmust be type-written, double-spaced, on one side of paper not largerthan A4 (297 mm x 210 mm). The first page of the typescript shouldbear the names of the author(s) and the name and address of thelaboratory or institution where the work has been carried out, inaddition to the title of the paper. The full address, telephone and faxnumber of the author to whom proofs will be sent should be given,together with up to four key words or phrases suitable for use in anindex. All pages should be numbered, including the title page. Allmaterial submitted is assumed to be submitted exclusively to thePostgraduate Medical Joumnal unless the contrary is stated. Papers maybe returned if presented in an inappropriate form. If the paper isrejected, these copies will not be returned. Authors are asked to submittheir approved manuscripts on computer discs. Guidelines will be sentwith the acceptance letter.

The principal authorThe principal author must ensure that any co-authors listed agree tosubmission of the typescript. Any written or illustrative materialwhich has been or will be published elsewhere must be dulyacknowledged and accompanied by the written consent ofthe copyrightholder.

StyleAbbreviations and symbols must be standard and SI units usedthroughout except for blood pressure values which are reported inmmHg. Acronyms should be used sparingly and fully explained whenfirst used. Whenever possible, drugs should be given their approvedgeneric name. Where a proprietary (brand) name is used, it shouldbegin with a capital letter. Statistical analyses must explain themethods used. Words to be italicised should be underlined. TheConcise Oxford English Dictionary is used as a reference for spellingand hyphenation. Figures and tables should be referred to in the text.

ArticlesOriginal articles are usually up to 3000 words long with up to sixtables/illustrations and 30 references. They should be divided into:Title page, Summary, Introduction, Materials and Methods, Results,Discussion, Acknowledgements, References, Tables, Figures andcaptions. The summary should not exceed 250 words and should stateconcisely what was done, the main findings and how the work wasinterpreted. Numbered paragraphs should be avoided. The use ofboxeswith learning/summary 'bullet' points is encouraged.

ReferencesReferences should follow the Vancouver style. In the text, they shouldappear as superscript numbers starting at 1. At the end of the paperthey should be listed (double-spaced) in numerical order correspond-ing to the order of citation. All authors should be quoted for paperswith up to six authors, for papers with more than six authors, the firstthree only should be quoted, followed by et al. Titles of medicalperiodicals should be given in full or abbreviated in line with the latestedition of Index Medicus. The first and last page numbers for eachreference should be provided. Abstracts and letters must be identified assuch. For example,

1 Clements R, Gravelle IH. Radiological appearances of hydatid disease inWales. PostgradMedJ 1986; 62: 167 -73.

2 Greenberger JS. Long-term hematopoietic cultures. In: Golde W, ed.Hematopoiesis. New York: Churchill-Iivingstone, 1984, pp 203 - 42.

Responsibility for the accuracy and completeness of references restsentirely with the authors.

Figures and tablesPhotographs, photomicrographs, line diagrams and graphs should beprepared to professional standards and submitted as originals or asunmounted glossy photographic prints. The identity of all patientsshould be masked (using a bar over the eyes) and written permissionfrom the patient included with the submission. When preparingillustrations which include lettering or symbols, remember they may

be reduced in size. All histology slides should contain a scale bar.Three copies of each illustration should be submitted, each bearing alabel on the back marked in pencil with the author's name and thenumber of the figure. Figure legends and tables should be typed onseparate sheets. Figures and tables should be numbered in arabicnumerals.

Short reportsShort papers or case reports should not exceed 1000 words, inclusiveof summary, introduction, report and discussion. Up to 10 referencesand two illustrations or tables will be accepted. Each report mustinclude (on a separate sheet) a list of learning or summary points.

Self-assessment questionsSelf-assessment questions may take several formats, including multiple-choice questions, (each consistingofa question stem and five items, withdiscussion ofthe correct answers, and up to five references per question)and photographic material (eg, clinical photograph, X-ray, blood film,histological section) or data interpretation (eg, ECG, arterial bloodgases), with clinical information and up to three questions withdiscussion of the correct answers, and up to five references per case.Authors whose case reports are rejected may be asked to considerresubmitting their report as a self-assessment question.

Review articlesThe Editorwelcomes review articles ofup to 3000 words, provided theycontain a clear educational message. The use of boxed casehistories, learning/bullet points and structured tables/summaries areencouraged. Guidelines for authors of review articles are availablefrom the Editorial Office, who are also happy to discuss proposedarticles.

EditorialsThe Editor is delighted to consider for publication unsolicitededitorials of 800 words. These will be peer reviewed.

Covering letterThe covering letter must be signed by all authors and include adeclaration that the paper is not under consideration by any otherjoumal at the same time and that it has not been accepted for publicationelsewhere.

Peer reviewAll papers are peer reviewed. Some are rejected after review by one ormore members ofthe Editorial Board. The remainder are also reviewedby one or more external advisors. Reasons for rejection will beindicated to the principal author. The Editor retains the customaryright to determine style and, if necessary, to shorten material acceptedfor publication.

LettersLetters to the Editor related to articles published in the PostgraduateMedical J7ournal are welcome. Only one copy need be sent, whichshould not exceed 500 words and five references. Authors whose shortreports are rejected may be asked to consider resubmitting their reportas a letter.

SupplementsGuidelines for supplements are available from the Editorial Office,who are happy to discuss proposed supplements.

Proofs and copyrightA marked proof will be sent to the principal author which should beread carefully for errors. The corrected copy must be returned to theTechnical Editor within three days. Major alterations to text cannot beaccepted.The principal author must complete and return to the Publisher the

Copyright Assignment Form enclosed with the proofs. He/she isresponsible for obtaining the signatures of all co-authors.

Reprints may be ordered at cost on a form accompanying theproofs.