Table Of Content

Postgraduate Medical Journal The Journal of Continuing Medical Education VOLUME 76 «+ 2000 Editor: John F Mayberry, Leicester Editorial Office: Pam de Chazal, Leicester Technical Editor: Sue Heels, London Statistical Advisor: Keith Abrams, Letcester Editorial Board Associate Editors Jane Dacre, London International Editors Nicholas London, Leicester Christopher Drew, Leatherhead Monica Acalovschi, Romania Andrew Hart, Norwich J Clive Gingell, Bristol M Aghiad Al-Kutoubi, Lebanon Rebecca Curran, Leicester Barry I Hoffbrand, London Nestor Angomachalelis, Huw Morris, London David Ingram, London Thessaloniki, Greece Graham Leese, Dundee Clive S Cockram, Editorial Board Alasdair Malcolm, London NT Shatin, Hong Kong Peter JB arnes, London Peter H Millard, London Jan Willem F Elte, Anthony H Barnett, Birmingham Michael Nicholson, Leicester Rotterdam, The Netherlands Malcolm C Bateson, Munir Pirmohamed, Liverpool Frederick F Fenech, St fulians, Malta Bishop Auckland Maurice Super, Manchester B Monappa Hegde, Mangalore, India Christopher J Bulpitt, London J Allister Vale, Birmingham V Jayanthi, Coimbatore, India D John Coltart, London Tom Walley, Liverpool A Suleiman Nayal, Dubai Gordon C Cook, London Philip D Welsby, Edinburgh Peter Tugwell, O Ontario, Canada VOLUME 76 * CONTENTS No 1 JANUARY 2000 Editorial Medical urology: a specialty long overdue. a personal view C M Castleden, H M Duffin Reviews Hepatocellular carcinoma S Badvie Cerebral venous sinus thrombosis H Allroggen, R ¥ Abbott Role of the vascular endothelium in patients with angina pectoris or acute myocardial infarction with normal coronary arteries 7 Sztajzel, F Mach, A Righetti The role of penile prosthetic surgery in the modern management of erectile dysfunction SJ ain, A Bhojwani, T R Terry Original articles Not if, but how: one way to talk with patients about forgoing life support R Léfmark, T Nilstun Clinical features and management of biliary ascariasis in a non-endemic area S P Misra, M Dwivedi Images in medicine Needles should not be re-sheathed A Huang, D Dutta Short reports Serial perfusion brain tomographic scans detect reversible focal ischaemia in Rasmussen’s encephalitis S Vinjamuri, JP Leach, I K Hart Eosinophilic fasciitis with pulmonary and pleural involvement 7 W W Killen, G L Swift, R$ White Increased prevalence of impaired hearing in patients with type 2 diabetes in western India A S Kashyap, S Kashyap Prolonged hypoglycaemia following surgical removal of phaeochromocytoma E B Fude, C B R Sridhar Self-assessment questions A young man with bronchial asthma and an abnormal chest x-ray A S Kashyap, S Kashyap A rare cause of right-sided abdominal pain in a young woman W K Edrees, M Hussien, M Ismail A lung cyst following blunt chest trauma P Sundaram, K Agrawal, D Balakrishnan, R T Kamble, ¥M foshi Neurological deterioration in a patient with myeloma A # Logan, ¥E Grey A 30-year-old man with stroke and skin lesions K N Viswanathan, S Anandan, S Sreenivas, K S Kumar, S Raman 51 A young man with a characteristic syndrome ¥ Ray, D O’Gradaigh, R Tighe 53 The collar sign K B Agrawal, R T Kamble, P Sundaram, ¥# M Foshi 55 An adolescence girl with an anterior mediastinal mass W S Chow, A WC Kung 57 A pain in the neck G V McDonnell, K E Bell, S A Hawkins Images in medicine Epidural lipomatosis Y Boutsen, ¥D onckier Book reviews International postgraduate diary Correction No 2 FEBRUARY 2000 Page Reviews 65 Otorhinolaryngology N Weir 70 Antiplatelet use in interventional cardiology A Brodison, R Katira, R S More, A Chauhan Widal agglutination test 100 years later: still plagued by controversy L A Olopoenia, A L King Original articles Cryptococcosis in aids P Imwidthaya, N Poungvarin Oral care of elderly patients: nurses’ knowledge and views A F Preston, S Punekar, M A Gosney The impact of hearing on communication L Fook, R Morgan, P Sharma, A Adekoke, C F Turnbull Short reports Spontaneous necrosis of parathyroid adenoma: biochemical and imaging follow-up for two years W B Chan, C C Chow, A D King, V T F Yeung, ¥K Y Li, W Y So, C S Cockram Acute myoedema: an unusual presenting manifestation of hypothyroid myopathy A Bhansali, V Chandran, F Ramesh, A Kashyap, R ¥ Dash Hepatocellular adenomatosis associated with hereditary haemochromatosis 7 M Radhi, ¥L oewy An aggressive intrasinusoidal lymphoma presenting with marked systemic disturbance but normal imaging studies R Camidge, E Ong, H Lucraft Aspergillus niger endocarditis in an immunocompetent patient: an unusual course Y Kreiss, Z Vered, N Keller, I Kochva, Y Sidi, H Gur Self-assessment questions Massive splenomegaly in tropical west africa G Bedu-Addo, #S heldon, I Bates A young man with dry skin and nodules on elbows and buttocks A S Kashyap, S Kashyap An unusual cause of cardiac failure N R Balcombe Acute q fever in a patient returning from the tropics P Parola, M Niang, S Badiaga, P Brouqui Exertional dyspnoea and nonproductive cough in a 22-year-old man C Usalan, S Emri www. postgradmedj.com Masked hypercalcaemia P M Byrne, R Freaney, M ¥ McKenna Multiple-choice questions Multiple-choice questions in thoracic transplantation medicine S W Dubrey, C Melikian, N R Banner Images in medicine Skull osteomyelitis and multiple brain abscesses H M Al Attia, RA Qureshi, 1 A El Hag Adverse drug reaction Haemolytic anaemia due to metformin A S Kashyap, S Kashyap Book reviews International postgraduate diary No 3 MARCH 2000 Page Reviews 129 Pitfalls in the interpretation of common biochemical tests R M Ayling 133. Amiodarone-induced thyroid disorders: a clinical review K-C Loh 141 Helicobacter pylori M C Bateson 145 Carbohydrate-deficient glycoprotein syndromes N Gordon Original articles 150 Evaluation of patients admitted with hypoglycaemia to a teaching hospital in central Anatolia M Giiven, F Bayram, K Giiven, F Kelestimur Prevalence of mental illness in a rehabilitation unit for older adults D C Shah, M Evans, D King Clinical audit Day-case percutaneous endoscopic gastrostomy: a viable proposition? A Mandal, A Steel, A R Davidson, C Ashby Short reports Recurrence of adrenal aldosterone-producing adenoma # Maria C-Romero, ¥ L Ramos-Salado Can myasthenia gravis be diagnosed with the ‘ice pack test’? a cautionary note A ¥ Larner, D # Thomas Syncope after effort M D Lowe, M C Petch Brittle Addison’s disease: a new variation on a familiar theme G V Gill, G Williams Chest pain, enzymes and hypothyroidism S R Strachan, O Afolabi, N Brown, D Gray Self-assessment questions Rapidly progressing tetraparesis in a young male patient with pyrexia S-A-W Fadilah, S-K Cheong, A-A Raymond Hyperthyroidism in an elderly patient P F Findlay, D G Seymour A case of intestinal obstruction N P Michell, H Routledge, I M Chesner Isosexual precocity: uncommon presentation of ac ommon disorder A Bhansali, A Kashyap, S Lodha, N Kotwal, B Ganapathi, B R Mittal, R J Dash Calf hypertrophy following paralytic poliomyelitis H Wilson, D Kidd, R S Howard, A F Williams, G T Spencer A healthy patient who suddenly developed a foot-drop G Plaut An unusual cause of bowel obstruction A Huang, D L McWhinnie, G P Sadler Adverse drug reaction Disseminated intravascular coagulation and vasculitis during propylthiouracil therapy J Khurshid, ¥ Sher Images in medicine Virtual endoscopy of the upper airway—a diagnostic tool R Eliashar, W Davros, I Eliachar Letters to the editor Book reviews International postgraduate diary No 4 APRIL 2000 Editorial Iron deficiency anaemiaa clinical challenge P Wurm, A C Wicks Reviews Does this elderly patient have iron deficiency anaemia, and what is the underlying cause? O M PJ olobe Primary biliary cirrhosis: new perspectives in diagnosis and treatment M I Prince, D E F Fones Original articles Management and outcome of brain abscess in renal transplant recipients M ¥ Arunkumar, V Rajshekhar, M F Chandy, P P Thomas, C K Facob Doctor or nurse? The patients’ choice A M Read, ¥ F Mayberry Influenza and pneumococcal vaccination: patient perceptions P F Findlay, Y M Gibbons, W R Primrose, G Ellis, G Downie Audit Audit of the investigation of iron deficiency anaemia in a district general hospital, with sample guidelines for future practice 7 M T Willoughby, S M Laitner Delivery of surgical care in a district general hospital without high dependency unit facilities R P Coggins Short reports A new cause of ‘non-responsiveness’ in coeliac disease? 7 S R Jennings, J I Wyatt, P D Howdle Sweet’s syndrome and subacute thyroiditis Y Kalmus, S Kovatz, L Shilo, G Ganem, L Shenkman www. postgradmedj.com Addison’s disease in type 1 diabetes presenting with recurrent hypoglycaemia V McAulay, B M Frier Galactorrhoea and pituitary mass: a typical prolactinoma? M Brdndle, C Schmid Advanced testicular cancer presenting with phlegmasia cerulea dolens C Mulatero, G Brogan, R T D Oliver Self assessment questions Fever and a rash in a 61 year old man D G Federman, R S Kirsner Painful knee: a dilemma A A Syed Back pain and dyspnoea in a middle aged diabetic male 7 Kelly, G Thorning, A Ozzard, K Kelleher A man with abdominal pain K H Siddiqui, 7 G H Hubbard A shot in the dark N R Bees, ¥ V Cook Pyrexia and pancytopenia with unusual host immune response Z N Singh, S Fain, S K Fain, S Rani Abdominal colic after vigorous exercise in a middle aged man A G Speers, S K Das Self assessment answers International postgraduate diary Adverse drug reaction Venlafaxine-induced serotonin syndrome with relapse following amitriptyline N K Perry No 5 MAY 2000 age Editorial Beyond Burkitt—is diverticular disease more than just cereal fibre deficiency? A R Hart, H ¥ Kennedy, N E Day Reviews Impact of HIV infection on tuberculosis A Zumla, P Malon, #H enderson, # M Grange Rickettsial diseases: the typhus group of fevers—a review G Cowan Role of smoking in inflammatory bowel disease: implications for therapy GA O Thomas, Rhodes, $ T Green, C Richardson Alcoholic liver disease K Walsh, G Alexander Original articles Heterogeneity of anti-PR3 associated disease in Hong Kong S-s Lee, ?W M Lawton Unreliability of cardiothoracic ratio as a marker of left ventricular impairment: comparison with radionuclide ventriculography and echocardiography A L Clark, A ¥ S Coats Causes of anorexia in untreated hyperthyroidism: a prospective study W-X Dai, X-W Meng Audit Diagnosis of malignant melanoma by general practitioners and hospital specialists A M Jackson, D R Morgan, R Ellison Case reports Crohn’s colitis and idiopathic thrombocytopenic purpura M S Boyne, K R Dye Osteomyelitis and possible endocarditis secondary to Lactococcus garvieae: a first case report P R Ffames, S M C Hardman, D L H Patterson Phaeochromocytoma unearthed by fluoxetine A S Kashyap Reversible sensorineural hearing loss after non-otological surgery under general anaesthetic H Pau, D Selvadurai, G E Murty Self assessment questions Progressive breathlessness in an 18 year old male M G Kelly, L G Heaney Sleeping eyes O Vancollie, E Delgrange, }D onckier Diffuse swelling of the penis in a young adult N S Krishna, E S Glen Hypercalcaemia in a 63 year old man L Ranganath, M F Semple Subacute haemorrhage into the spinal cord F¥ ¥ Craig, R S Cooke, 7 P McCann Self assessment answers Adverse drug reaction Risperidone implicated in the onset of tardive dyskinesia in a young woman S Kumar, D M Malone Letters to the editor Diary No 6 JUNE 2000 Reviews Chemotherapy for upper gastrointestinal tumours A L Thomas, K O Byrne, W P Steward Advances in gastroenterology and hepatology M C Bateson Progressive supranuclear palsy H U Rehman Original articles Permanent pacemaker insertion in a district general hospital: indications, patient characteristics, and com- plications A Eltrafi, P Currie, H Silas Trends in diagnostic and therapeutic criteria in Graves’ disease in the last 10 years F Escobar-Fiménez, M L Feérnandez-Soto, V Luna-Lopez, M Quesada-Charneco, D Glinoer Status of antithyroid antibodies in Bangladesh M A Hasanat,M A K Rumi, M N Alam, K Nadim Hasan, M Salimullah, M A Salam, M Fariduddin, H Mahtab, A K Azad Khan Evaluation of amlodipine, lisinopril, and a combination in the treatment of essential hypertension M UR Naidu, P R Usha, T R K Rao, 7C Shobha www. postgradmedj.com Audit Use of a computerised maternity information system to improve clinical effectiveness: thromboprophylaxis at caesarean section G M Taylor, C A McKenzie, G ¥ Mires Teaching medical undergraduates basic clinical skills in hospice—is it practical? A L Franks Adverse drug reaction Hypersensitivity syndrome caused by amitriptyline administration H 7 Milionis, A Skopelitou, M S Elisaf Case reports Primary amyloidosis of the larynx A Daudia, M Motamed, S Lo Extensive psoriasis induced by interferon alfa treatment for chronic hepatitis C Taylor, D A Burns, M F Wiselka Histoplasmosis of the small bowel in patients with aids M A Gumbs, H Girishkumar, A Yousuf, L Levy, M Patel, V Narasimha Pseudovitamin d deficiency rickets—a report from the Indian subcontinent A H Zargar, A Mithal, A I Want, B A Laway, S R Masoodi, M I Bashir, M A Ganie Self assessment questions An unusual presentation of a common disorder G Hall, B Mc Namara, ¥R ay, S Boniface Young male with recurrent flaccid quadriparesis and complete recovery A S Kashyap, S Kashyap Swelling in the caesarean section scar M Hussien, 7W R Peyton An unusual case of chorea gravidarum A Qasim Nausea and vomiting, a cause for concern? A Ala, N Arnold, C C Khin, N van Someren Self assessment answers Book reviews Diary No 7 JULY 2000 Editorial Evidence based medicine overviews, bulletins, guidelines, and the new consensus R R West Reviews Pulmonary arteriovenous malformations: a clinical review M Iqbal, L # Rossoff, H N Steinberg, KA Marzouk, D N Siegel Arrhythmogenic right ventricular dysplasia. An illustrated review highlighting developments in the diagnosis and management of this potentially fatal condition N G Fisher, T F Gilbert Diagnosis of pneumothorax in critically ill adults 7 ¥ Rankine, A N Thomas, D Fluechter Original articles Role of carotid sinus syndrome and neurocardiogenic syncope in recurrent syncope and falls in patients referred to an outpatient clinic in a district general hospital A Eltrafi, D King, ¥H Silas, P Currie, M Lye Aortic aneurysm and dissection are not associated with an increased risk for giant cell arteritis/polymyalgia rheumatica M Ehrenfeld, R Bitzur, ¥S chneiderman, A Smolinsky, Y Sidi, H Gur Commentary—arteritis in Western surgical practice N 7 M London Chest pain and non-respiratory symptoms in acute asthma W M Edmondstone Audit Referral for autopsies: analysis of 651 consecutive deaths in one general practice K Khunti Adverse drug reaction Hypoparathyroidism unmasked by alendronate A S Kashyap, S Kashyap Commentary—bisphosphonates and calcium homoeostasis M Pirmohamed Images in medicine Lingual thyroid S Basaria Case reports Drug induced chest pain—rare but important P Davey, D G Lalloo Milk alkali syndrome—an unusual syndrome causing an unusual complication S George, ? D A Clark Primary hypothyroidism masquerading as hepatic encephalopathy: case report and review of the literature N Thobe, P Pilger, M P Jones Turkish pepper (extra hot) A Woywodt, A Herrmann, M Chot, U Goebel, F C Luft Self assessment questions Metabolic acidosis in an Afro-Caribbean man with hyperpigmentation D A Darko, N N Chan, A Fackson, C Peiris, D O’Shea Swelling of a metacarpophalangeal joint A Kumar, A P Thomas A 30 year old male with headache and abnormal cranial magnetic resonance imaging A S Kashyap, S Kashyap Sudden hemiplegia after a mctorcycle accident A M-H Ho, 7 D Wells A young man with acute paraparesis H M S Elasha, D Footitt, #G ibson, T ¥ Wilkin Pain in the right wrist S Shyamsundar, A L Pimpalnerkar Atypical cellulitis D Ray, M Khakhar, A Flowerdew An interesting electrolyte problem R T Sadikot, I M Robbins Respiratory compromise relieved by laparotomy A Bali, D A Walker, F P Iredale, C D Fohnson Chronic non-healing ulcers of the scalp after trauma V Kulkarni, V Rajshekhar An unusual complication of carcinoma of the caecum Y Ramkissoon, H Ghoorahoo, S F Haydock, K M O’Shaughnessy Self assessment answers Letters to the editor Diary www. postgradmed}.com No 8 AUGUST 2000 " Editorial Safe practice of endoscopy M A Quine, D Colin-Fones Reviews A clinicopathological classification of granulomatous disorders D Geraint James «ndomysial antibody in the diagnosis and management of coeliac disease M W James, B B Scott Chronic inflammatory bowel disease in children: a complex problem in management7 A Walker-Smith Mucins and inflammatory bowel disease T Shirazi, R ¥ Longman, A P Corfield, C S F Probert Pathophysiology of chronic bacterial osteomyelitis. why do antibiotics fail so often? ¥C iampolinz, K G Harding Foreign bodies in the nasal cavities: a comprehensive review of the aetiology, diagnostic pointers, and therapeutic measures A Kalan, M Tariq Original articles Ultrasonographic findings and differentiation of benign and malignant focal splenic lesions Y L Wan, Y C Cheung, K W Lui, FfH Tseng, T Y Lee General surgery in haemophiliac patients E Bastounis, E Pikoulis, A Lepp niemi, D Alexiou, C Tsigris, A Tsetis Audit Management of spontaneous pneumothorax—a Welsh survey 7 H Yeoh, S Ansari, I A Campbell Adverse drug reaction Anaphylactoid reactions to paracetamol O T Ayonrinde, B M Saker Commentary—anaphylactic reactions to paracetamol I Stephenson, ¥M D Nightingale Case reports Alcoholic hepatitis—the case for intensive management 7 O’Beirne, D Patch, S Holt, M Hamilton, A K Burroughs Bilateral adrenal non-Hodgkin’s lymphoma with adrenal insufficiency R D Ellis, D Read Self assessment questions A 60 year old woman with axillary mass R Bansal, S Mehandru, A Goel, MF ain Renal colic in a young woman N Sarath Krishna,J Sinclair An unusual cause of watery diarrhoea 7N Gordon A patient presenting with hoarseness K-H Lim, C-K Liam, C M-M Wong Young male with headache, blindness, and hypogonadism A S Kashyap Right shoulder pain in a body builder S Shyamsundar, A L Pimpalnerkar Unexpected elevation of parathyroid hormone in an asymptomatic patient with multiple endocrine neoplasia syndrome type 2A P Wiesli, ¥ Furrer Self assessment answers Book reviews CD-ROM review Diary Correction No 9 SEPTEMBER 2000 Editorial 7 Specialty secondments for accident and emergency registrars M Lindley-fones, A Bose Reviews © Thyroid disordersan update 7 H Lazarus, K Obuobie Hearing impairment in older people: a review L Fook, R Morgan Recent advances in ischaemic heart disease M Cusack, S Redwood, } Coltart Video assisted thoracoscopic surgery S C Stoica, W S Walker Ophthalmology and general medicine A Karseras USSIr Ne Difficulties in diagnosing and treating depression in the terminally ill cancer patient M Lloyd-Williams vUi &wLa&uo i ©uue uwGrwawdennnig o’s syndrome M Motamed, A Kalan Images in medicine Multifocal breast cancer K S Hindle, A Huang Original articles High prevalence of iliofemoral venous thrombosis with severe groin infection among injecting drug users in North East Scotland: successful use of low molecular weight heparin with antibiotics A R Mackenzie, RB S Laing, } G Douglas, M Greaves, C C Smith Investigating lymphadenopathy—report on the first 12 months of the lymph node diagnostic clinic at the Royal Marsden Hospital R K Gregory, D Cunningham, T A Fisher, P Rhys-Evans, G W Middleton, L Bishop, A Wotherspoon, P A Trott, A G Nash Audit Frequency of proteinuria in type 2 diabetes mellitus seen at a diabetes centre in southern India V Mohan, R Meera, G Premalatha, R Deepa, P Miranda, M Rema Adverse drug reaction Indomethacin induced avascular necrosis of head of femur K R Prathapkumar, I Smith, G A Attara Case reports Base of tongue varices associated with portal hypertension P Jassar, M Ffaramillo, D A Nunez Cefuroxime induced lymphomatoid hypersensitivity reaction S A M Saeed, M Bazza, M Zaman, K S Ryatt Colonic carcinoma after ureterosigmoidostomy A Huang, GA D McPherson www. postgradmed).com Web site review International herpes management forum (www.ihmf.org) T G Stammers Self assessment questions A pulmonary mass and hyperviscosity 7 A Corless, D F Allsup, T # Deeble, ¥C Delaney Abdominal pain in a 22 year old woman T Asselah, O Ernst, V Canva,F Paris A rare cause of unilateral hearing loss O A Osinubi, I Lauder, R S A Thomas A difficult psychiatric patient M # Henderson A rare case of radiculopathy in an elderly man W K Edrees, B Lee How can fruits and sugar induce headache and hypoglycaemia? V Y Kopyev, E Lozner Self assessment answers Multiple choice questions in evidence based medicine W-C Leung Letters to the editor Diary No 10 OCTOBER 2000 > ~=Editorial Challenges in medical education—what the doctor ordered? M Severs, S Crane Reviews Pharmacological treatment of Parkinson’s disease A Miinchau, K P Bhatia A lay doctor’s guide to the inflammatory process in the gastrointestinal tract S Pathmakanthan, C # Hawkey Review of cryptogenic fibrosing alveolitis, including current treatment guidelines S C Bourke, H Clague Association of anticardiolipin antibodies with vascular injury: possible mechanisms Y S Haviz Behcet’s disease V Kontogiannis, R F Powell Original articles Emptiness of the left iliac fossa: a new clinical sign of sigmoid volvulus V Raveenthiran Single photon emission computed tomography in tuberculous meningitis U K Misra, ¥K alita, B K Das Closed pelvic fractures: characteristics and outcomes in older patients admitted to medical and geriatric wards R O Morris, A Sonibare, D F Green, T Masud Adverse drug reaction QT prolongation due to roxithromycin A Woywodt, U Grommas, W Buth, W Rafflenbeul Commentary—QT prolongation due to roxithromycin A Malcolm Case reports An unusual case of pyrexia of unknown origin with cervical lymphadenopathy P Wurm, G Townson, I Lauder, A C Wicks Carotid sinus syndrome masquerading as treatment resistant epilepsy S W Parry, RA Kenny Chorea disclosing deterioration of polycythaemia vera EF R Nazabal, 7M Lopez, P A Perez, P R Del Corral Self assessment questions A case of migratory lymphadenopathy and cutaneous anergy in an asian woman H M A Artia, Y HA Ahmed, A El Hag, R N El Abassi Multiple focal lesions in liver and spleen in acute leukaemia S Ghai, S Thulkar, P N Purushothaman, S Sharma A pregnant patient with bilateral ischaemic limbs N B Teo, N Mamode, D P Leiberman Severe symptomatic hypercalcaemia ¥ M Calvo-Romero, M del C Bonilla-Gracia Self assessment answers Letter to the editor Diary No 11 NOVEMBER 2000 Editorial Adipose tissue, the anatomists’ Cinderella, goes to the ball at last, and meets some influential partners C M Pond Reviews Management of leg ulcers P K Sarkar, S Ballantyne Pregnancy and the lungs P Bhatia, K Bhatia Unknown primary tumours H F P Hillen Original articles Influence of smoking on asthmatic symptoms and allergen sensitisation in early childhood S M Tariq, EA Hakim, S M Matthews, S H Arshad Gallstones and cholecystectomy in modern Britain M C Bateson Case reports Disseminated fungal infection complicated with pulmonary haemorrhage in a case of acute myeloid leukaemia S Thulkar, S Sharma, P K Das, L Kumar Primary haematogenous osteomyelitis of the patella: a rare cause for anterior knee pain in an adult R K Kankate, T P Selvan Neuralgic amyotrophy as a presenting feature of infective endocarditis P English, D Maciver Sweet’s syndrome in association with Crohn’s disease A Vaz, K Kramer, R A Kalish www. postgradmedj.com Images in medicine Dental anomalies in Williams syndrome A S Kashyap, H S Sharma, P Kumar Self assessment questions A case of digital vasculitis MA M Abbas, C S Arun, A N Gorsuch, E B Henderson Abdominal wall thickening in a middle aged man M Bhushan, R H Macdonald, M H Irving, C E M Griffiths NDVAI 71 year old man with a facial lesion M Saab The pale and limping child S A W Fadilah, S K Cheong, S Shahdan nNonen“oe In ~ Rigidity, hyperthermia, and altered mental status # M Calvo-Romero, M del C Bonilla-Gracia, J L Ramos-Salado, P Bureo-Dacal A rare cause of recurrent meleana in an elderly women B Spencer, A Akpan, D King Abdominal lump in an infertile man B M Biswal, M Madhavan, S R Anas A vanishing pituitary mass N Norman Chan Shortness of breath and diffuse chest pain S Singh, A A Lone, B A Khan, A K Khan, M M Wani An elderly man with muscle cramps N Younis, I F Casson Left kidney mass in a 45 year old woman G Brancatelli, M Galia, G Sparacia, S Cusmé, R Lagalla e|rose WWdWHeNHwYSY I Self assessment answers Audit The real cost of aspirin M I Burgess, C G Densem, N H Brooks, R D Levy, H S Lee Adverse drug reaction Indomethacin induced psychosis D Tharumaratnam, S Bashford, S A Khan History of medicine Perceptions of malaria transmission before Ross’ discovery in 1897 G C Cook, A ¥ Webb Book reviews Diary No 12 DECEMBER 2000 Reviews Diagnosing physical child abuse: the way forward M A Barber, ¥R Sibert The pathophysiology of common causes of syncope W Arthur, G C Kaye Sacrococcygeal teratoma in the perinatal period R Tuladhar, S K Patole, ¥ S Whitehall Whipple’s disease R N Ratnaike Leukotriene receptor antagonist therapy O 7 Dempsey Guillain-Barré syndrome U Seneviratne Original articles Implementation of antithrombotic management in atrial fibrillation S_¥ McNulty, D Hutchinson, K ¥ Hardy Safety of low dose methotrexate in elderly patients with rheumatoid arthritis B Hirshberg, M Muszkat, O Schlesinger, A Rubinow Case reports Recurring febrile illness in a slaughterhouse worker K N Ganeshram, A Ross, R P W Cowell, C Cefai, M F Woodward Reiter’s syndrome following intravesical BCG immunotherapy M B Hogarth, S Thomas, M H Seifert, S M Tariq Telesales neuropathy M B Lewis Adverse drug reaction Complete dysphagia after thrombolytic treatment for myocardial infarction T Mosimann, L Terracciano, C Steber, F Rappo Self assessment questions 7197 Hepatic abscess in a diabetic patient ¥ Valabhji, S Robinson, R S Elkeles 798 Broad complex tachycardia: a diagnostic dilemma V Adhiyaman, S Froese, A Vaishnavi, R Cowell 799 Bilateral fractures of the second metatarsals S Shyamsundar, A L Pimpalnerkar 799 Thyrotoxicosis of a rare aetiology M Ismail, R V Bhat 800 Iatrogenic recurrent severe hypercalcaemia and renal impairment T Sulkin, A ¥ Krentz 801 Two cases of acute chest pain 7 Tharakan, E Seth, A Radwan 802 Self assessment answers Audit 809 Management of pericardial effusion by drainage: a survey of 10 years’ experience in a city centre general hospital serving a multiracial population C R Gibbs, R D S Watson, S P Singh, G Y H Lip Images in medicine Renal and extrarenal autosomal dominant polycystic kidney disease S Basaria, N N Mehta Book reviews Diary Index www. postgradmedj.com