Premenarcheal anorexia nervosa

The notions of 'early-onset' and 'prepubertal' anorexia nervosa are reviewed, with particular reference to the role of the pubertal process within the condition. A database of 650 female cases is utilized to identify a small sub-group (n = 30) who developed the condition before the menarche. Many clinical, familial, social and precipitating factors distinguish this group from post-pubertal cases as a whole, and a sub-group of post-menarcheal cases (n = 42) matched for age. An explanation for previous inconsistent findings in 'early-onset' and 'prepubertal' anorexia nervosa is advanced.

Section 136 and African/Afro-Caribbean minorities

Social, demographic and clinical information was collected retrospectively on all 99 people referred to a South London hospital in 1986 under Section 136 of the Mental Health Act (1983), this being the last complete year before local changes in the procedure for assessment of Section 136 cases were initiated. An over-representation of Afro-Caribbeans was confirmed and this seemed to be accounted for largely by young men under the age of 30 who with Africans had very high rates of previous Section 136 referral, were more likely to be perceived as threatening, incoherent and disturbed but less clearly diagnosed with a mental illness, and were more likely than the Caucasian sample to be living in stable accommodation. The implications of these results are discussed.

Association of muscle strength with functional status of elderly people

We have studied the association of muscle strength (quadriceps, biceps, handgrip), measured by a portable chair technique, with functional status (Barthel Index, manual dexterity, Mental Test Score, history of falls, fracture, prescribed drugs), in a sample of 92 elderly subjects attending a Local Authority Day Centre and Day Hospital. Anthropometric measurements and hand-grip strength were also measured in 30 young controls. Muscle area, mass and strength were significantly greater in young controls. Elderly men had significantly greater muscle area, mass and strength than elderly women. Muscle strength correlated with several measures of functional status. Using stepwise multiple regression, an independent association of muscle strength with manual dexterity, Barthel Index and receipt of domiciliary services is demonstrated.

Follow-up of balloon aortic valvuloplasty in young adults--a combined hemodynamic and Doppler echocardiographic study

Percutaneous Balloon Valvuloplasty was performed in 25 patients with severe aortic stenosis (Aortic valve area index: 0.23 to 0.70, mean 0.36 +/- 0.11 cm2/m2). The mean age was 23 +/- 15 (range 6-66) years, and majority (n = 18) had noncalcific valves. Valve morphology was bicuspid in 14, tricuspid in 6 and indeterminate in 5. Valvuloplasty resulted in a fall of peak systolic gradient (PSG) from 112 +/- 35 to 34 +/- 16 mmHg (p less than 0.001), and an increase in aortic valve area (index) (AVAI) from 0.36 +/- 0.11 to 0.82 +/- 0.43 cm2/m2 (p less than 0.001). Follow-up data at 16 +/- 6 months were available for 18 patients, 80 per cent of whom registered symptomatic improvement. Repeat catheterization, performed in 12 cases, showed increase of PSG to 53 +/- 22 mmHg and a fall in AVA (1) to 0.62 +/- 0.24 cm2/m2, as compared to the results immediately following the procedure. In addition, 3 patients had their valve areas estimated by doppler echocardiography. Forty-six per cent of these 15 patients (n = 7) showed evidence of restenosis. Four out of these 7 cases had calcific valves, whereas none of the patients who had sustained improvement had calcification. Tricuspid morphology was present in 50 per cent of the group with sustained improvement, as compared to 20 per cent of the group that restenosed. Our preliminary data shows sustained hemodynamic improvement after balloon dilatation in young patients with severe aortic stenosis with noncalcific and tricuspid aortic valve.

Prevalence and clinical significance of coronary artery ectasia (an angiographic study)

Coronary cine-angiograms of 1,042 patients were reviewed for the presence of ectasia of major coronary arteries. Ectasia or irregular dilatation of the coronary artery was defined as 1.5 times diffuse or segmental dilatation as compared to segment of normal caliber coronary artery. Forty-one (3.9%) patients were found to have diffuse or localised coronary artery dilatations with segments of normal caliber throughout the length of major vessels. Mean age of the patients was 52 years, and majority were males (39, 95%). Right coronary artery (RCA) and left circumflex (Cx) were involved in 23 (56%) each, left anterior descending (LAD) in 15 (37%), obtuse marginal in 4 (10%) and left main in 2 (5%). Multiple vessel involvement was present in 21 (51%). Evidence of myocardial infarction was present in 21 (51%). Major risk factors were not different from the patients with coronary artery disease without ectasia.

Post-infarction ventricular septal defect: the importance of site of infarction and cardiogenic shock on outcome

Sixty-eight patients operated upon for post-infarction VSD from 1980-1987 have been reviewed to identify incremental risk factors which influence survival. Univariate and multivariate analysis was performed on 19 parameters and showed the following in decreasing order of importance to be significantly associated with non-survival: (1) operation within 24 h of occurrence of the VSD; (2) inferior infarct preceding the VSD; (3) requirement for inotropic support preoperatively; (4) preoperative cardiogenic shock; (5) a lower mean pulmonary artery pressure; (6) a lower mean wedge pressure; (7) a lower mean systolic pressure. The presence of a graft to the right coronary artery was associated with a better prognosis. Age, sex, diastolic blood pressure, balloon pumping, mean plasma urea, right atrial pressure, extent of coronary disease, number of coronary grafts, grafts to the left coronary system and method of myocardial preservation had no influence on survival.

Double-blind placebo-controlled trial of amitriptyline among depressed patients in general practice

Depressed patients in general practice were included in a double-blind placebo-controlled six-week trial of amitriptyline (median dose 125 mg). The patients were relatively mildly ill and satisfied diagnostic criteria for depression and treatment with antidepressants in routine practice. Amitriptyline was found to be considerably superior to placebo after six weeks and significantly so as early as two weeks after the start of treatment. The effects of the antidepressant were on the core symptoms of depression, and were apparent in all but the most mildly ill patients. The findings suggest that tricyclic antidepressants are of considerable therapeutic benefit to depressed patients in general practice.

D-penicillamine-induced acute hypersensitivity pneumonitis and cholestatic hepatitis in a patient with rheumatoid arthritis

Acute hypersensitivity pneumonitis is not a known side effect of D-penicillamine. Also, there are only a few reports of cholestatic hepatitis caused by this drug. The present report describes a case of rheumatoid arthritis where these manifestations appeared in the same patient ten days after the institution of D-penicillamine therapy. The etiological relationship with the drug was established, inadvertantly, by its accidental intake by the patient 5 months later with the reproduction of the same manifestations.

Serum levels and response to amitriptyline in depressed out-patients

Serum levels of amitriptyline plus nortriptyline were measured by radioimmunoassay at 1 and 6 weeks in depressed out-patients treated with amitriptyline for 6 weeks. Serum concentrations at 6 weeks were higher in older patients. Serum levels showed no relationship to clinical response at 6 weeks, and a week inverse relationship with response at 2 weeks. Routine monitoring of serum levels appears to be of little value in depressed out-patients treated with amitriptyline.