MÜNCHAUSEN'S SYNDROME (HIV INFECTION): A TRAP FOR THE UNWARY

SUMMARY A case of Münchausen's syndrome with AIDS illustrates the need for a high index of caution when dealing with individuals whose histories are inconsistent and suspicious, particularly when they have moved area.     

PLASMA XANTHINE LEVELS IN PREMATURE INFANTS TREATED FOR APNOEA WITH THEOPHYLLINE

Evidence is presented that oral theophylline doses of 3 mg per kg per 24 h in premature babies produces plasma levels of theophylline and caffeine of about 5 and 1–2 mg/l respectively in most subjects.     

SLEEP APNOEA: CAUSES,CONSEQUENCES AND TREATMENT

An awakening has taken place over the last 25 years to the science of sleep disorders. Foremost amongst these, both in the medical world and the public eye, has been Sleep Apnoea Syndrome (SAS). The prevalence is thought to be of the order of 1–2%.^1,2 Males are eight times more commonly affected than females, although after the menopause the gap narrows considerably. Sleep apnoea occurs in children, usually in relation to large tonsils and adenoids, but in adult life patients usually present between the age of 40 and 60 and the prevalence increases with age. Numerous apnoeas or hypopnoeas during the night's sleep result in disordered sleep architecture and unrefreshing sleep. This is usually accompanied by night-long snoring which may lead to marital discord and even complaints from neighbours. Symptoms on waking may be a headache and a feeling of not being refreshed by sleep. Sleepiness during the day can interfere with work and social activities and may produce risks to the patient and others if it occurs while operating dangerous machinery or driving. Over a longer time scale SAS results in intellectual and memory deterioration, a higher incidence of ischaemic heart disease, hypertension, polycythemia and pulmonary hypertension. Right heart failure is particularly likely if there is chronic airflow obstruction contributing to a low arterial oxygen level. Asystolic periods and tachyarrhythmias may occur during apnoeic periods. The increased mortality of SAS relates to coronary and cerebrovascular disease and arrhythmias. Sudden death occurs with greater frequency in patients with SAS, mainly at night.³     

FEMINISM: A PERSPECTIVE FOR THE 21st CENTURY

This article details some of the key elements related to feminism in American society. It suggests that the meaning and significance of a feminist perspective need to be reexamined for their importance and utility in this dynamic and rapidly changing society. A discussion of the meaning of feminism provides a framework for the article. Issues related to cultural diversity and the need for competent health care delivery for all people are some major themes. The other emphasis is related to research and women. Numerous challenges are outlined. A feminist perspective is recommended as a conceptual model through which health care reform can be enhanced. If feminism were embraced, the health status of people would be improved.     

THE LABELLING OF DISPENSED MEDICINES FOR THE ELDERLY PATIENT: A PILOT SURVEY

The problems that elderly patients encounter when managing their own drugs were approached from the point of view of the understanding that these patients have of the labels on dispensed medicines. Thirty medically qualified volunteers at Burton District Hospital Centre were used to evaluate the adequacy of the present handwritten, labelling system for elderly out-patients by the use of a questionnaire. Further, by means of structured interviews with thirty elderly out-patients and a discriminating test procedure, the proposed, new, typed, labelling system was compared with two other labelling systems, the ability of the patients to understand the labels determined and the efficiency of the proposed, new system tested. The trends indicated by this pilot survey are that the present system of handwritten labels is inadequate and inefficient. Medical staff may repeatedly go over instructions and patients identify their drugs by means other than the label. Regardless of the quality of the label the regimen for a particular patient often determines the necessity for repeat instructions. Further, the proposed, typed, labelling system was ranked last by staff and patients when compared with two other systems (Ladywell and Thomas). The ability of patients to understand typed labels was very low. A new labelling system based on these trends is proposed.     

ENDOTOXEMIA AND ADRENAL HEMORRHAGE : A MECHANISM FOR THE WATERHOUSE-FRIDERICHSEN SYNDROME

An experimental model that produces adrenal cortical hemorrhage with endotoxin has been described. When stimulated by thorotrast, endotoxin, or its tropic hormone (ACTH), the adrenal cortex is susceptible to the development of a hemorrhagic reaction during endotoxemia. The hemorrhagic reaction resembles that described in the Waterhouse-Friderichsen syndrome. A pathophysiologic mechanism for the occurrence of adrenal hemorrhage occurring during acute sepsis is presented. Increased metabolic activity associated with the production of corticosteroids seems to make the adrenal cortex susceptible to endotoxin-induced hemorrhage. Adrenal hemorrhage observed during sepsis, as in the Waterhouse-Friderichsen syndrome, may be attributable to endotoxemia occurring during or shortly after stimulation of the adrenal cortex by infection. Significant differences between adrenal cortical hemorrhage and the Shwartzman phenomenon are described.     

A TEST FOR ANTITHROMBIN IN THE BLOOD

A test is described for the estimation of antithrombin in the blood. The chief advantage of the test is that it is simple, and does not require the preparation of fibrinogen and of thrombin, which are difficult to prepare and to maintain in a pure state. The principle consists in titrating the antithrombin against normal human plasma; in this way we obtain an estimation of its power to delay coagulation. As the result of examinations carried out by this method, it would seem that there is a wide factor of safety as regards the amount of antithrombin in the human blood, and that this inhibiting substance may be increased to a considerable degree without markedly delaying or endangering clotting.     

THE LOSS RESPONSE LIST: A TOOL FOR MEASURING ADOLESCENT GRIEF RESPONSES

Single adolescent girls aged 13-19 years participated in pilot (n=40) and follow up (n=164) studies to develop the reliability and validity of the Loss Response List (LRL). The LRL measures physical, emotional, social, and cognitive grief responses by comparing groups based on pregnancy status (never pregnant, pregnant, perinatal loss, and perinatal loss and pregnant). The pilot study revealed significant results on emotional, social, and cognitive grief responses between the perinatal loss and no-perinatal loss groups. Follow-up study results indicated significant differences between the perinatal loss group and the other groups on grief subscales. Significant differences also occurred between perinatal loss and never pregnant groups on depression. The LRL should be useful in gathering information about adolescent grief responses, including perinatal loss.     

CONCERNING THE POSSIBILITY OF AN ANTIBODY FOR THE TETANOPHILE RECEPTOR OF ERYTHROCYTES: A RECEPTOR STUDY

The treatment of washed erythrocytes of the guinea-pig by a heated immune hemolytic serum derived from the rabbit, and of washed erythrocytes of the sheep by a similar serum derived from the goat, renders the erythrocytes more or less resistant to the subsequent action of tetanolysin. If all the serum is removed from corpuscles treated in this manner, it can be determined that some of the protection is due to the agglutination of the cells. A certain amount of the protection afforded by agglutination is referable to the physical barrier which the agglutinated mass of cells offers to the uniform distribution and diffusion of the tetanolysin. It is probable that none of the protection obtained is due to the mere union of agglutinin or of hemolytic amboceptors with their respective cell-receptors; such union would appear to leave the tetanophile receptors still unoccupied. If a residuum of serum is left with the corpuscles which have been treated as indicated, the added protection which is acquired against the subsequent action of tetanolysin may reasonably be referred to antitoxin which is present in the residual serum. The possibility of the dissociation of a union between the tetanophile receptor and its antibody, occasioned by the dilution incident to washing away the serum, may not be entirely ignored, but has not been susceptible to determination. The same may be said of the possibility that tetanolysin, having a stronger affinity for the tetanophile receptor than has the antibody, is able to displace the latter from its union with the receptor. Hence treating corpuscles with the immune serums does not allow one to determine the presence or absence of an antibody for the tetanophile receptor, the experiments being formulated on the supposition that such an antibody would unite with the tetanophile receptors and thereby prevent subsequent binding of tetanolysin.