An unusual case of pancreatic cancer with leptomeningeal infiltration.

Introduction: Pancreatic cancer is a common malignancy and often presents at an advanced stage. Metastases are common but neurological involvement is rare. We aim to describe an unusual case of leptomeningeal involvement from pancreatic cancer.

Percutaneous endoscopic gastrostomy in a military hospital.

Percutaneous endoscopic gastrostomy (PEG) is a simple, relatively safe and cost effective means of establishing enteral access for patients requiring long term nutritional support. PEG has several advantages over surgical gastrostomy and should be considered the procedure of choice for long term enteral therapy in appropriate patients. At the Queen Elizabeth Military Hospital (QEMH) between June 1992 and October 1993 thirteen percutaneous endoscopic gastrostomies were successfully performed.

A case of factitious fever and 'epilepsy'.

We describe the case of a 23 year old male who presented with a history of intermittent pyrexia associated with apparent episodic loss of consciousness. During these events, thermometers placed in the rectum and axillae supported the elevated oral temperature readings. After numerous investigations including electroencephalography had excluded organic disease, the patient was observed applying a hot douche to his rectum prior to his temperature being recorded.

Chronic pancreatitis in the British Army 1978-1989.

A retrospective study was made of all 28 soldiers with chronic pancreatitis first diagnosed between 1978 and 1989. All patients were male, alcohol was the aetiological factor in 90%, the mean age at diagnosis was 30 and the commonest mode of presentation was with recurrent painful episodes of pancreatitis. Endocrine and exocrine pancreatic insufficiency occurred in a quarter and a third of patients respectively and one third required surgical intervention.

Controlled clinical trial of doxorubicin and tamoxifen versus doxorubicin alone in hepatocellular carcinoma.

Following reports that specific estrogen receptors could be detected in samples of hepatocellular carcinoma tissue, a prospective randomized controlled trial was undertaken in 59 patients, half of whom received doxorubicin (60 mg/m2 at 3-week intervals) and half doxorubicin and tamoxifen (10 mg twice per day). Response occurred in three (11%) of those patients receiving doxorubicin alone and in four (16%) of those given both drugs. This difference was not statistically significant nor was the difference in survival when compared by life-table analysis.

Hilar gland tuberculosis in Nepalese adults masquerading as malignant lymphoma.

We report two Nepalese patients with tuberculosis, in whom the sole chest X-ray abnormality was hilar lymphadenopathy. This rare variant of tuberculosis, not previously described in Nepalese patients, may easily be mistaken for malignant lymphoma.

Use of propranolol to reduce the rebleeding rate during injection sclerotherapy prior to variceal obliteration.

In a prospective, randomized controlled trial, 53 patients with variceal hemorrhage from portal hypertension, including 44 with cirrhosis, were allocated, after initial control of the bleeding, to treatment by sclerotherapy alone, or by this together with oral propranolol in a dose sufficient to reduce resting pulse rate by 25% during the period up to the time when varices were obliterated. Eight of the 27 patients undergoing sclerotherapy alone rebled during this period as compared to 7 of the 26 patients in the additional propranolol group (p greater than 0.80), two patients from each group dying from uncontrollable variceal hemorrhage.

Heat illness. A report of 45 cases from Hong Kong.

During the summer of 1985, 45 soldiers with heat illness were admitted to the British Military Hospital, Hong Kong. Twelve had severe heat stroke, the remainder heat exhaustion. This paper discusses the management and prevention of heat illness in the military context.

Polyresistant malaria in Gurkha soldiers returning from Papua New Guinea: treatment and prevention.

Two company strength exercises to Papua New Guinea produced 21 malaria casualties of whom 16 had potentially fatal falciparum infections. The chemotherapy and prevention of polyresistant malaria from Papua New Guinea and the threat posed to the Hong Kong environment regarding malaria re-introduction are discussed.

Failure of malaria chemoprophylaxis with a proguanil-chloroquine combination in Papua New Guinea.

Proguanil 200 mg daily and chloroquine base 300 mg weekly were used as prophylaxis for 120 British Army soldiers from Hong Kong on a seven-week jungle exercise in the highly malarious Sepik district of Papua New Guinea. Compliance was rigidly enforced. Four men developed falciparum malaria whilst in Papua New Guinea and one within a few days of returning to Hong Kong.

The Budd-Chiari syndrome. Possible pathogenetic role of anti-phospholipid antibodies.

The case of a young woman with the Budd-Chiari syndrome is reported. She first noticed abdominal symptoms following a late spontaneous abortion. Antiphospholipid antibodies were detected in her serum.

Risk factors in development of hepatocellular carcinoma in cirrhosis: prospective study of 613 patients.

In a prospective study of 613 patients with cirrhosis of different aetiological types increasing age, male sex, and non-UK nationality were found to be significant independent risk factors for the progression of cirrhosis to hepatocellular carcinoma. Seropositivity for hepatitis B surface antigen and the duration and aetiology of cirrhosis were not related to the development of the disease. Age and sex were also found to be significant risk factors when UK patients alone were considered.

B1 selective adrenoreceptor blockade for the long term management of variceal bleeding. A prospective randomised trial to compare oral metoprolol with injection sclerotherapy in cirrhosis.

Oral metoprolol, in a dose sufficient to reduce resting pulse rate by 25%, was compared with repeated injection sclerotherapy for the long term management of variceal bleeding. The prospective, randomised study was undertaken in 32 patients with biopsy proven cirrhosis and variceal bleeding who were Grade A or B on a modified Child's classification. In the 15 patients receiving metoprolol, portal pressure showed a mean fall of 3.

Mitozantrone as single agent therapy in hepatocellular carcinoma. A phase II study.

Thirty-five patients with hepatocellular carcinoma (HCC) have been treated with the Anthracenedione derivative, Mitozantrone. One complete and 5 partial responses were seen in 22 evaluable patients and in a further 4 patients tumour size remained static for lengths of time ranging from 13 to 42 weeks. Therapy was well tolerated.

Hepatocellular carcinoma in primary biliary cirrhosis: detection by alpha-fetoprotein estimation.

Serial estimations of serum alpha-fetoprotein in 130 white patients from the United Kingdom with primary biliary cirrhosis who were followed for periods of 1-52 mo revealed 5 cases of hepatocellular carcinoma; all were subsequently confirmed histologically. At the time alpha-fetoprotein was first noted to be elevated, none had signs or symptoms of tumor development. Of the 52 patients who died during the follow-up period, hepatocellular carcinoma was the cause of death in 3 (33%) of the 9 men, and 2 (5%) of the 43 women.

Effect of cytotoxic chemotherapy on hepatitis B viral markers in patients with hepatocellular carcinoma.

The titre of HBsAg in the serum of patients with HBsAg seropositive hepatocellular carcinoma rose in 12 (80%) of 15 cases during chemotherapy with either adriamycin or etoposide and in five cases there was at least a four-fold rise in titre. Anti-HBs and anti-HBc status did not change and serum markers of HBV infection did not become apparent in the 32 patients who were seronegative at presentation. The chemotherapy-related rise in HBsAg titre did not appear to be responsible for deterioration in hepatocellular function and it was not associated with any change in HBeAg/anti-HBe status.

Injection sclerotherapy for oesophageal varices: a prospective randomised trial of different treatment schedules.

A prospective randomised study to compare the efficacy and complications of injection sclerotherapy carried out at intervals of one week and three weeks up to the time obliteration of varices was achieved, was undertaken in 55 patients (48 cirrhosis, six portal vein thrombosis, one nodular regenerative hyperplasia). The number of courses of injection required for obliteration of the varices was not different in the two groups and despite a shorter time scale for obliteration in the weekly treated patients the frequency with which further episodes of bleeding occurred before that was not significantly less. Mucosal ulceration during the period required for obliteration was observed at endoscopy more frequently in the weekly treated patients but was not associated with a greater frequency of postinjection pain, dysphagia or of long term stricture formation.

Hepatocellular carcinoma in the non-cirrhotic liver: a comparison with that complicating cirrhosis.

The clinicopathological features of 50 patients with hepatocellular carcinoma arising in a non-cirrhotic liver are described and compared with those of 100 patients in whom the tumour arose as a complication of cirrhosis. The non-cirrhotic patients were significantly younger, more often female and had a less strong association with serum markers of hepatitis B virus infection. Liver function tests and serum AFP were less often abnormal and survival was significantly better than in the cirrhotic group.

A prospective randomized study of two sclerotherapy techniques for esophageal varices.

In a study designed to compare the efficacy and safety of two techniques of injection sclerotherapy, 40 patients (30 with cirrhosis and 10 with portal vein block) were randomly allocated to the sheath or free-hand technique. Although the former was associated with significantly less bleeding within the first 24 hr of injection (p less than 0.05) but more postinjection pain (p less than 0.

Polyneuropathy: an unreported non-metastatic complication of primary hepatocellular carcinoma.

A patient with hepatic cirrhosis is described, who presented with a sensorimotor polyneuritis at the time of the development of a primary hepatocellular carcinoma. Typical clinical and electrodiagnostic features of a paraneoplastic peripheral neuropathy, not previously reported in hepatocellular carcinoma, were found on investigation.

Hepatocellular carcinoma complicating chronic granulomatous hepatitis.

The development of hepatocellular carcinoma, is reported in a patient with chronic granulomatous hepatitis after a seven year interval in which clinical and biochemical improvement had occurred on corticosteroid therapy and in whom, the development of cirrhosis was excluded by liver biopsy.