Biomedical subjects
Publications and source records attributed to S Hall.
A 60-year-old male with adenocarcinoma of the rectum had the acute onset of complete oculomotor palsy with pupillary sparing. Computed tomography scan and sellar tomograms demonstrated an ipsilateral parasellar mass with bony destruction. This case illustrates the need for a thorough search for metastatic disease in patients with third nerve palsy and known carcinoma.
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Status epilepticus is a medical emergency. Recent experimental studies have shown that permanent brain damage can occur after only 60 minutes of uncontrolled seizure activity. Cardiac arrhythmias are a common cause of death. Other complications include rhabdomyolysis, acute tubular necrosis and neurogenic pulmonary edema. Management is divided into three phases: stabilization of the patient, termination of the seizures and diagnostic evaluation.
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Three cases of giant cell arteritis that developed in patients with known seropositive rheumatoid arthritis are described. The coexistence of these 2 conditions has been felt to be unusual. The diagnostic difficulties encountered when 2 such inflammatory conditions coexist are discussed.
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Ninety-nine males with gout were identified and their radiographs examined for features of vertebral hyperostosis and entheseal changes (diffuse idiopathic skeletal hyperostosis, DISH). Of patients over the age of 45 years 43% fulfilled criteria for diagnosis of DISH. New bone formation in other regions of the skeleton was also common. The overhanging margin sign, seen in well developed tophi, was noted only in patients with prominent new bone formation elsewhere in their skeleton. Some of the radiologic manifestations of gout may be modified by a co-existent tendency, in these patients, to form new bone. It is suggested that a common metabolic factor, possibly hyperinsulinaemia, underlies the association of gout and hyperostosis.
A case of adult onset Still's disease is reported. A middle aged woman presented with prolonged high fever, rash, polyarthritis, leukocytosis and abnormal liver function tests. The clinical features and multisystem nature of this condition are emphasised.
The ionophore A23187 (10 micrograms/ml) did not affect the uptake of D-[U-14C]xylose by rat soleus muscle incubated under basal conditions. When muscles were incubated in a Ca2+/Mg2+-free (CMF) medium, A23187 promoted the efflux of intracellular Mg2+ and the efflux of 45Ca from preloaded muscles. Under these conditions, conditions, A23187 inhibited insulin-stimulated sugar transport without affecting 125I-insulin binding by the muscle. A23187 induced a slight fall in muscle ATP (16-18%); this does not appear to be responsible for the inhibitory effect of the ionophore on sugar transport. The inhibitory effect of A23187 was completely abolished when the CMF medium was supplemented with Mg2+ and partially reversed by Mn2+ or Zn2+; supplementation with Ca2+ did not reverse the inhibitory effect of the ionophore. These results suggest that insulin stimulates muscle sugar transport through a mechanism that involves intracellular Mg2+.
The acetylator phenotype of 53 hypertensive patients and 5 patients with ulcerative colitis was assessed by determination of the percentage acetylated sulphadimidine in serum and urine related to creatinine clearance. Of the 58 patients, 30 were slow and 27 rapid acetylators, one patient was indiscriminate. The fraction acetylated sulphadimidine excreted in urine tended to decrease with decreasing creatinine clearance in both slow and rapid acetylators. In a 6-hour serum sample, on the other hand, the fraction of acetylated sulphadimidine appeared to be independent of the glomerular filtration rate in rapid acetylators. In slow acetylators, however, the acetylators, fraction increased with decreasing creatinine clearance. The sulphadimidine between rapid and slow acetylators even in cases with severe renal insufficiency. Analyses of 6-hour serum samples are to be preferred but urine samples can also be used if corrected according to creatinine clearance.
To test the efficacy of screening urine specimens of methadone maintenance clients as a deterrent to illicit drug use, the authors randomly assigned 431 subjects to a monitored or an unmonitored group for 1 year. Monitored subjects continued to provide urine specimens once a week; unmonitored subjects did not. All other aspects of treatment remained the same. At 4 and 8 months after the study began, surprise urine collections were conducted. There was no difference between the groups in the proportion of drug-free specimens at either time.
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Urodynamic investigation was performed in 100 consecutive incontinent women. The clinical diagnosis was confirmed in only 65 women and management was significantly altered in 31 women. Pressure-flow studies should precede, whenever possible, the treatment of incontinent patients.
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A case report of a catatonic patient is presented. Because of the similarity of catatonia to the animal behavior produced by intracerebral administration of beta-endorphin, an endogenous opioid, naloxone was administered. No effect was observed with naloxone, whereas both amobarbital and diazepam were able to reverse catatonic behavior. Testing of catatonic patients with naloxone may help further elucidate naloxone's reported anti-psychotic properties.