Biomedical subjects
Publications and source records attributed to R W Orrell.
Testosterone is recognized to have a positive effect on nitrogen balance and muscle development in hypogonadal men, but significantly myopathy secondary to testosterone deficiency has been reported only rarely. We describe a patient who presented with a myopathy associated with testosterone deficiency, and who demonstrated a significant functional and myometric response to treatment.
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The neck-tongue syndrome, consisting of pain in the neck and altered sensation in the ipsilateral half of the tongue aggravated by neck movement, has been attributed to damage to lingual afferent fibres travelling in the hypoglossal nerve to the C2 spinal roots. The lingual afferents in the hypoglossal nerve are thought to be proprioceptive. Two further cases of the neck-tongue syndrome are described, the spectrum of its clinical manifestations is explored, and the phenomenon of lingual pseudoathetosis is illustrated as a result of the presumed lingual deafferentation.
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A thirty-year-old man with traumatic quadriplegia, was also found to have weakness above the level of the injury. He had facial weakness, difficulty in swallowing, and recurrent respiratory problems. A diagnosis of myotonic dystrophy was supported by examination of his sister. The problems of diagnosis, and the implications of the diagnosis on the management of the patient with myotonic dystrophy and a spinal injury are discussed.
Controlled trials have been instigated, comparing the results and complications of chorionic villus sampling (CVS) and amniocentesis. At present most attention has focused on the miscarriage rate, which itself requires large numbers to provide studies of reasonable power. This paper describes a case of stillbirth due to massive placental abruption following CVS. The size of trial needed to provide sufficient power to detect a range of realistic postulated changes in the incidence of this or other important possible complications is calculated. It would appear that the size of sample required is very large, and that present trials will not succeed in detecting possible important differences in late obstetric, neonatal, and other long term complications of the procedure.
The level of plasma viscosity associated with the diagnosis of giant cell arteritis, and its use as a replacement for the erythrocyte sedimentation rate (ESR) is examined, by reviewing the records of 59 patients undergoing temporal artery biopsy. All patients with positive temporal artery biopsy had plasma viscosity above the upper limit of normal (1.72 mPa.s), range 1.88 to 2.28. There was a large group of patients with a possible diagnosis, supported by a raised plasma viscosity, who in the absence of a positive biopsy were not felt to have clinical disease requiring steroid treatment. The role of plasma viscosity appears to be similar to that of the ESR in the diagnosis of giant cell arteritis.