The state of the prisons
TL;DR: Points Effects of perforated appendicitis in girls on subsequent fertility (W G Mills); Eld(er)ology (G Smelt); Not . . . achalasia (F W Wright); Potentiation of oral anti?
Abstract: Fetal monitoring during labour R S Sawers, mrcog. 484 Rational treatment of asthma P W Ind, mrcp. 484 Addiction to aerosol treatment I M Slessor . 485 Adrenocortical suppression in multiply injured patients: a complication of etomidate treatment H D Chee, md, and others; R W Logan, frcpath, and Josephine I McKee, mrcpath 485 Ethical dilemmas of brain failure in the elderly G S Robertson, ffarcs; P H Millard, frcp; J Kellett, frcpsych . 486 Standardisation of oral anticoagulant treatment A M H P van den Besselaar, phd, and others 486 Infection with netilmicin resistant Serrada marcescens M W Casewell, mrcpath, and Philomena Ronan, bsc . 487 Impact of audit on preventive measures R G H Bethel, mrcgp . 487 Screening for asymptomatic bowel cancer in general practice N C Armitage, frcs, and J D Hardcastle, mchir . 488 Institutional malnutrition A Burns, mrcp. 488 Arthritis in Roman Britain Juliet Rogers, MB, and P Dieppe, mrcp_488 Oxygen as a driving gas for nebulisers: safe or dangerous? S J Austin, MB, and C Chan, mrcp. 488 Development of a strategy for higher education I M Richardson, frcped; B H Taylor, bsc(econ) . 488 No man is an island J Callander, mrcgp. 489 Points Effects of perforated appendicitis in girls on subsequent fertility (W G Mills); Eld(er)ology (G Smelt); Not . . . achalasia (F W Wright); Potentiation of oral anti? coagulants by ketoconazole (T K Daneshmend); Calcium antagonists in hypertension (J J Jones); Kawasaki syn? drome (M B McEvoy and S M Hall); BMA sponsored candidates for GMC election (R G Watson) . 489
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TL;DR: A 23-year-old woman developed weak arms and legs and diplopia during her second pregnancy and neuropathy relapsed over the next five years until she presented with deteriorating pulmonary function and an inability to cough due to muscle weakness, for which she required artificial ventilation.
Abstract: Case 1?A 23-year-old woman developed weak arms and legs and diplopia during her second pregnancy. On examination she had a mild peripheral sensory disturbance, definite distal muscle weakness, and absent tendon reflexes. Cerebrospinal fluid (CSF) protein was 20 g/1. The neuropathy relapsed over the next five years until she presented with deteriorating pulmonary function and an inability to cough due to muscle weakness, for which she required artificial ventilation. She was given atropine and thiopentone to induce anaesthesia and then paralysed with suxamethonium (succinylcholine) before in? tubation. During this procedure she developed a ventricular tachycardia, which returned promptly to sinus rhythm with intravenous lignocaine and DC cardioversion. Case 2?A 42-year-old man presented with paraesthesia in the hands and feet and left-sided facial weakness. Over the next seven months his arms and legs became progressively weak, extending proximally. He was almost completely paralysed in the arms, legs, and trunk and had a peripheral sensory dis? turbance and absent reflexes. CSF protein concentration was raised at 2-84 g/1. Because he could not cough effectively and his respiratory function was deteriorating he required artificial ventilation. He was given atropine 0-3 mg, thiopentone 200 mg, and suxamethonium 75 mg intravenously before intubation. His pulse was lost immediately, and ECG monitoring showed ventricular tachycardia, which progressed to ventricular fibrillation. He was given intravenous lignocaine and cardio verted on four occasions before returning to sinus rhythm. No further arrhythmias were noted. Case 3?A 75-year-old man was admitted with a five-month history of progressive weakness of the legs. On examination he had flaccid paralysis of all muscle groups with absent tendon reflexes. CSF protein concentration was 3-2 g/1. He developed purulent sputum and a chest radiograph showed consolidation in the right lower lobe. Because he was unable to cough and blood gas concentrations were falling he was intubated, artificial
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TL;DR: Measurement of this age-dependent ratio, which may be made with any electrocardiographic apparatus, provides a simple, accurate diagnostic screen for autonomic neuropathy in the clinic.
Abstract: A study was carried out to establish a normal range for use in a deep breathing test of cardiac vagal integrity in diabetes mellitus. The change in heart rate resulting from taking a deep breath was recorded in 174 healthy subjects aged 16-89 years. Results were expressed as the ratio of the longest R-R interval during expiration to the shortest R-R interval during inspiration. This ratio declined appreciably with age (p less than 0.001) but was not significantly related to resting heart rate. An age-related normal range was constructed and its diagnostic value investigated in 134 diabetics (aged 15-70 years) with various degrees of neuropathy. The sensitivity for indicating autonomic dysfunction was high: six false-negative and one false-positive result were obtained. Measurement of this age-dependent ratio, which may be made with any electrocardiographic apparatus, provides a simple, accurate diagnostic screen for autonomic neuropathy in the clinic.
206 citations
TL;DR: It is concluded that the technique described can be used to test cardiac autonomic function at the bedside and variations in interval length at rest and during deep breathing depended on age and the mean interval length, whereas the Valsalva ratio depended onAge alone.
Abstract: 1. A computer-based technique is described for measuring and analysing cardiac beat-to-beat intervals. 2. The R-R intervals were recorded at rest, during forced deep breathing and during the Valsalva manoeuvre in 174 healthy subjects aged between 16 and 89 years. 3. The mean resting R-R interval was independent of sex, age and smoking habit. The normal range was 654.6-1141.4 ms with a mean value of 864.7 ms. 4. Variation in interval length at rest and during deep breathing depended on age and the mean interval length, whereas the Valsalva ratio depended on age alone. Normal ranges were calculated from regression analysis of these relationships. 5. It is concluded that the technique described can be used to test cardiac autonomic function at the bedside.
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TL;DR: The results suggest that this test of R‐R variations of the ECG is a reliable method for establishing and following an autonomic dysfunction in patients with Guillain‐Barré syndrome.
Abstract: As we have earlier shown, variations in the R-R interval of the ECG can be used as a measure of autonomic function. This test was applied to 6 patients with Guillain-Barre syndrome at different times during the course of the disease. Severe but temporary impairment of autonomic function was found, which was maximal at 2-6 weeks after the onset of clinical symptoms and gradually improved to normal levels over a period of 3-18 months. This paralleled clinical recovery. The results suggest that this test of R-R variations is a reliable method for establishing and following an autonomic dysfunction in patients with Guillain-Barre syndrome.
55 citations