Acute spinal epidural abscess--a cause of meningism.
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Biomedical subjects
Publications and source records attributed to M J Ford.
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The gastric emptying rate was measured in 10 female patients with primary anorexia nervosa and 12 healthy volunteers, using a scinti-scanning technique for the simultaneous study of the liquid and solid components of a test meal. The emptying rate of both the liquid and the solid phase components of the meal was significantly slower in patients with anorexia nervosa. The aetiological and therapeutic implications of this finding are discussed.
One hundred and thirty-two women consecutively referred to a hospital obesity clinic were studied. Only 31 per cent attended for a year or more. The mean weight loss achieved by the 88 women who lost weight was 6.7 kg. The principal reason and degree of motivation for losing weight were not related to either the weight loss or the length of attendance. The initial anticipated rate of weight loss (AROWL) was of no predictive value, though this was influenced because all patients were given a 'realistic' AROWL at their first clinic visit. These results suggest that although specialist clinics may have a specific role to play, at present, obesity is a problem best dealth with on a community basis.
Non-oliguric renal failure developed in six elderly women who had been prescribed 1--2 g of mefenamic acid daily for 2--6 weeks for the relief of musculoskeletal pain.
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Two cases of mycoplasma pneumonia are described which failed to respond to prolonged treatment with erythromycin. The substitution of oxytetracycline therapy resulted in rapid clinical and radiological resolution.
TSH response to TRH stimulation was studied in 40 non-obese control females and in 40 obese female subjects 40-148 per cent in excess of their ideal weight prior to receiving dietary advice. One patient was found to be hypothyroid and was excluded from further study. There was no significant difference between the basal serum TSH concentration in the subjects and controls. Obese subjects however had significantly greater serum TSH concentrations at 20 and 60 min following TRH stimulation. The implciations of these findings are at present unexplained.
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One hundred consecutive patients with an ESR of 100 mm or more in the first hour admitted to a general medical unit were studied. Their mean age was 67 years and forty-seven were male. Three patients recovered without a satisfactory diagnosis. In thirty-three of the remainder a single diagnosis was considered responsible for the elevation of the ESR, and in the others multiple diagnoses were found. Infection was found in 60% of patients, malignancy in 28% (including 7% with myelomatosis), rheumatoid disease in 20% and renal disease in 11%. 34% of patients died within 6 months of entry into the study. In the absence of rheumatoid disease or a paraproteinaemia, elevation of the ESR in excess of 60 mm in the first hour at 1 month or longer was associated with a particularly poor prognosis. This study has shown the diagnostic implications of an ESR of 100 mm or more in the first hour and the prognostic significance of a persistent elevation of the ESR.
In a series of thirty-seven consecutive patients with polymyalgia arteritica, twenty-five had polymyalgia rheumatica and twelve had cranial arteritis. Some failed to respond promptly to low doses of prednisolone and it is recommended that the initial dose should be in the order of 40 mg daily. An ESR above 40 mm in the first hour was present in four patients 3 months after admission; three were found to have rheumatoid disease and one pulmonary tuberculosis. Symptomatic relapses occurred in fourteen patients on twenty-one occasions and all responded to an increase in the daily dose of maintenance prednisolone. Most occurred in the first year and were attributable to an excessively rapid reduction in steroid therapy. Relapses occurring in patients on a stable dose of prednisolone were commonly associated with the development of rheumatoid disease. In elderly patients who have relapsed, or who have had arteritic complications, life-long prednisolone therapy appears justifiable.
A case of leiomyoma of the duodenum presenting with sub-acute intestinal obstruction and a palpable abdominal mass is described. Both the siting of the lesion in the duodenum and a presentation other than gastro-intestinal bleeding are unusual for this type of tumour.
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When sarcoidosis of the renal parenchyma occurs it is rarely of major clinical significance. The clinical features and post-mortem findings of a case of subacute uraemic syndrome due to severe granulomatous involvement of the kidney by sarcoidosis are described. The case is unusual in that granulomatous sarcoid nephropathy resulted in death from renal failure within 4 months of onset of symptoms in the absence of clinically apparent sarcoidosis.
One hundred patients in whom an Erythrocyte Sedimentation Rate (ESR) in excess of 100 mm. in the first hour was found on 2 consecutive occasions were investigated. Serum protein electrophoresis was performed on 96 of these patients and bone marrow examination on 55 patients. Acute infection was the commonest diagnosis though the majority of patients had 2 or more separate conditions each contributing to the elevation of the ESR. Quantitive serum protein electrophoresis was abnormal in all but one patient and was of limited diagnostic value. A definite band in the globulin region was detected in 11 patients, 7 of whom were found to have myelomatosis. Bone marrow examination was useful only in patients with a discrete band in the globulin fraction or with a specific haematological abnormality. It is suggested, therefore, that bone marrow examination be confined to patients with such abnormalities irrespective of an elevation of their ESR.
Forty-two female patients with refractory obesity completed a 20-week double-blind study during which they were given a diet designed to provide not more than 40 mg vitamin C and 1000 kcal (4.2 MJ) daily. Twenty-two of the patients took 600 mg of supplementary vitamin C daily and the remainder, a matched placebo. All were given their highest tolerated dose of fenfluramine up to a maximum of 160 mg daily. There was no significant difference in the mean weight loss of the two groups. This study fails to support the hypothesis that the anti-obesity effect of fenfluramine is influenced by the vitamin C intake.
Fifty women with refractory obesity received fenfluramine for 20 weeks. Every two weeks details of weight change, drug dose, degree of anorexia, and any side effects were recorded and plasma was obtained for fenfluramine and norfenfluramine measurements. Of the 41 patients available for final analysis 26 achieved a maximum plateau dose of 160 mg/day. Plasma fenfluramine concentrations did not correlate with the degree of anorexia or with the incidence of side effects other than the severity of dream disturbance. There was a highly significant relation between weight loss and plasma fenfluramine and norfenfluramine concentrations and also between weight loss and the presence of sustained anorexia. Women who achieved mean plateau concentrations over 200 ng/ml lost a mean 8.8 kg while those with concentrations less than 100 ng/ml lost a mean of only 2.1 kg. When fenfluramine is prescribed in refractory obesity the dose should be increased stepwise until either satisfactory weight loss is achieved or troublesome side effects appear.