Twins and eating disorders.
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Biomedical subjects
Publications and source records attributed to J G Solomon.
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One hundred and seven cases of oral verrucous carcinoma treated primarily with radiotherapy at Kasturba Hospital, Manipal, India between 1977 and 1987 were analysed concerning location within the oral cavity, clinical extent, and effectiveness of radiotherapy. The most common site was the buccal mucosa followed by the buccogingival sulcus. Only 13.2% of the patients presented with T1 or T2 tumours and 32.7% had clinically negative nodes. Biopsy had to be repeated more than once in 22 patients to get confirmation of invasive carcinoma. The 5-year survival rate was 35% for stage III and 26% for stage IV. The treatment results with radiotherapy were comparable with those for ordinary squamous cell carcinoma of the oral cavity. It is felt that the treatment policy for verrucous carcinoma can be the same as for ordinary squamous cell carcinoma. In order to prevent delay in diagnosis and treatment, proper cooperation between the treating oncologist and the pathologist is essential.
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Epileptiform seizures occurred in a 34-year-old woman who was receiving amitriptyline and lithium carbonate therapy for treatment of endogenous depression. While receiving amitriptyline maintenance therapy, she was given lithium on two separate occasions, and despite serum levels of lithium in the therapeutic range, grand mal seizures developed. The seizures may represent a toxic reaction either to lithium or to combined drug therapy. Controlled studies are needed to evaluate both the efficacy and toxicity of combined drug therapy in affective disorders.
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Studies show that many clinicans "write off" elderly patients as demented, when in fact many of these patients are not suffering from chronic organic brain syndrome but have medical disorders that may respond positively to appropriate treatment. The key to differentiation is comprehensive diagnostic evaluation.
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Modifications in technique, including the use of anesthesia and muscle-relaxing drugs, make electroconvulsive therapy safe and easy to administer. There are few contraindications, complications are rare, and efficacy is well-documented.
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The author presents a case report of a manic-depressive patient who developed dysarthria and ataxia while on lithium maintenance. These symptoms were erroneously attributed to lithium toxicity occurring at therapeutic serum levels. However, the symptoms persisted despite diminution in lithium dosage and a neurological consultation revealed the diagnosis of multiple sclerosis. The author concludes that lithium therapy is effective with manic-depressive patients, that adverse side effects are infrequent and can occur at toxic or therapeutic serum lithium levels, and that the exceptional patient may have a second illness incorrectly attributed to lithium toxicity.
Two cases of recurrent psychotic depression are reported in which ECT (electroconvulsive therapy) was administered with good results for previous episodes of depression, but treatment of the current episode with combined drug therapy (antidepressant and antipsychotic drugs) in one case and antidepressant chemotherapy in the other resulted in failure to improve. The patients were transferred to another facility, and improved when ECT was administered. Pertinent literature on ECT and drug treatment of depression is reviewed, and the conditions for which ECT is probably the treatment of choice are enumerated.
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A case of folie a deux is presented in which the child is the dominant psychotic partner and his mother is the passive partner in whom a paranoid psychosis is induced. The conditions under which folie a deux may occur, the diagnosis, and the treatment of the disorder are discussed.