Chorea disclosing deterioration of polycythaemia vera

Neurological manifestations occur frequently in polycythaemia. Chorea, however, is a rare complication of the disease. A case of chorea in a patient previously diagnosed with polycythaemia vera is reported. Choreic movements started after measurement of haematological variables showed deterioration. It was considered that this was caused by inappropriate treatment with iron because the chorea was markedly reduced after the two first venesections and normalisation of the packed cell volume and haemoglobin parameters.     

6: Movement disorders II: the hyperkinetic disorders

Involuntary movements or hyperkinesias are classified into syndromes of chorea, ballism, tremor, dystonia, myoclonus and tics. The hyperkinesias are caused by disturbances in the circuitry connecting the cerebral cortex, thalamus, basal ganglia and cerebellum. Drugs are a common cause of movement disorders. The aim of management is to characterise the movement disorder, identify and treat the cause or institute symptomatic treatment. The genetic basis of many movement disorders is increasingly recognised. Where there are potential implications for family members, accurate diagnosis and counselling are particularly important.     

Diagnosis and Treatment of Chronic Cough due to Gastroesophageal Reflux Disease

Gastroesophageal reflux disease is one of most common causes of chronic cough.Medical history offers few clues as to the cause of cough induced by this disease.24-h esophageal ph monitoring is considered as the most sensitive and specific test for the diagnosis.When it is unavailable or unsuitable,upper gastrointestinal endoscopy and barium esophagography can be used as an alternative examination.Combined multichannel intraluminal impedance and pH testing is promising because of its ability to detect nonacid reflux as well as acid reflux.Empiric therapy trial is a simple and cheap way to identify suspected patients.Drug therapy is effective in most of the patients,in which proton pump inhibitors is the most powerful.Antireflux surgery is the last choice,used only when intensive drug therapy fails.The definitive diagnosis of cough due to gastroesophageal reflux disease can be established only after cough improves or completely disappears with antireflux therapy.     

Clonazepam in the treatment of choreiform activity.

In a limited study, clonazepam, a new benzodiazepine derivative, has been found to be effective in suppressing choreiform movements in three patients with Huntington's chorea, three patients with non-familial chorea, and in one patient with senile chorea. In two patients with chorea of doubtful aetiology the response was not very satisfactory. A simple method was used to assess objectively the effect on choreiform movements. The effective dose varied from 3-5 to 5-5 mg a day. The drug was well tolerated by most of the patients.     

Pharmacotherapeutics in the elderly

Drugs are the most cost-effective modality of chronic care, and older adults with multiple illnesses often need multiple drugs. Because this may lead to drug interactions, adverse drug effects, and problems with compliance, drug regimens should be individualized and as few drugs as possible used. When a new drug is indicated, it is important for the physician reassess the appropriateness and continued need for the existing regimen. Patients and providers must agree on a particular regimen, its goals, promises, and limitations.     

Fingerprint Patterns in Huntington's Chorea and Parkinson's Disease

In the course of a continuing search for means of predicting Huntington's chorea before the onset of neurological symptoms, a study of fingerprint patterns was undertaken, using the technique employed by Hodges and Simon in the investigation of patients with Wilson's disease. Fingerprint patterns of 61 patients with Huntington's chorea and 50 with Parkinson's disease were compared with norms established by Scotland Yard. Although an increased incidence of the “whorl” pattern was seen in the left second and third fingers in patients with Huntington's chorea, this finding could not be interpreted as having diagnostic or prognostic value as it was found also in some normal subjects and in occasional cases of Parkinson's disease. The pattern supposedly characteristic of Wilson's disease was also seen in persons with Huntington's chorea.     

Identification of adverse reactions to new drugs. IV--Verification of suspected adverse reactions

The verification processes were assessed for 18 important adverse drug reactions. Verification when achieved by formal studies was not obtained through cohort studies such as postmarketing surveillance or other follow up of drug users but through case-control studies or a similar disease orientated approach. When not achieved in this way the most useful aspects of uncontrolled studies were rechallenge and dose-response data. Analysis of the data and of the characteristics of different methods of verification suggested that there were four approaches to earlier discovery. (1) The best system seemed to be some form of record linkage, capable of providing at the same time data on incidence of adverse reactions and on prevalence of drug usage in patients with disease suspected of being drug induced. Until such a system can be established the relative efficacy of alternative approaches appears to be (2) review of all published first alerts, with prompt initiation of case-control or disease orientated studies for verification, (3) postmarketing surveillance of cohorts of drug users, and (4) voluntary reporting systems.     

Ethics of predictive testing for Huntington's chorea: the need for more information

The finding of a genetically linked polymorphic DNA marker has made possible a predictive test for Huntington's chorea. This DNA probe has so far been used only for research and has technical limitations, but some workers now wish to apply it to clinical predictions. Those identified by the probe as being probable carriers of the Huntington's chorea gene would be exposed to uncertain psychological risks and social pressures. Ethical guidelines should be established, but these require greater knowledge of the potential benefits and hazards of this powerful new procedure. Controlled clinical trials are urgently needed.     

Novel gelatin-adriamycin sustained drug release system for intravesical therapy of bladder cancer

In recent years,progress has been made in sus-tained and controlled drug release system,and manybiodegradable high molecular materials have beenused in human body.Asa drug cancer,the sustainedand controlled drug release system must be able toentrap drug in its molecularnetwork,and once intro-duced into human body,it can be degraded by pro-teinase,resulting in sustained release of drug.Gelatin is such a high molecule with good histocom-patibility.In this study,we impregnated adriamycininto a 2 …     

Limits of confidentiality.

A patient is described, a woman of 60, who at that age was diagnosed as having Huntington's chorea, a genetic disease which is transmitted as an autosomal dominant. She had one daughter, who was married and lived abroad. The patient's mother and maternal aunt, it emerged during the consultations, had had the disease, and shortly after the diagnosis had been made the patient's sister was admitted to hospital with a repiratory condition, and in the course of treatment Huntington's chorea was diagnosed in her also. She had one daughter. Throughout, the problem was not only that of treating the patient herself, but the situation of all those of the family affected in any way. The patient's husband had not known of her medical history at the time of the marriage. At no time had the daughter been told. The discussion, in which seven doctors, a moral philosopher, and a social worker took part, centered on the basic issue of confidentiality in the case of a disease, from which would stem problems for the affected family through several generations. All were agreed that in these circumstances those affected must be told, but differed as to who should make some of the subsequent decisions. Some thought that having told of the diagnosis and its implications, the doctor should leave further decisions to those concerned; others that in a disease such as Huntington's chorea one is looking at part of a whole chain of genetic material, and, although the individual patient or potential patient is of course important, he or she must be seen in the genetic setting of the community. The participants also considered the psychological.     

Chorea complicating polycythemia rubra vera

A patient with polycythemia rubra vera and chorea is described and the literature on this rare combination is reviewed. This is the first report of the association of chorea and polycythemia in a male patient.

The contrasting features of other forms of diffuse cerebral pathology which may be accompanied by chorea, namely disseminated lupus erythematosus, Henoch-Schönlein purpura and rheumatic chorea, are discussed.

     

AIDS and the medicolegal experts

Forensic medicine deals both the living (eg, sexual assaults) as well as dead (eg, rape followed by murder) and drug induced death cases. In drug induced death or sexual assault cases some of the victims are sufferers of AIDS. HIV transmission occurs more in free and unlimited sex. Some points are to be remembered as the safety devices while a case of suspected HIV person is examined or autopsy is conducted. These points are elaborated in this article. Some legal implications are looked into while handling such cases with evidence of AIDS. These are also discussed.     

Torsades de pointes occurring in association with terfenadine use

Torsades de pointes is a form of polymorphic ventricular tachycardia that is associated with prolongation of the QT interval. Although found in many clinical settings, torsades de pointes is most often drug induced. This report describes the first association (exclusive of drug overdose) of symptomatic torsades de pointes occurring with the use of terfenadine in a patient who was taking the recommended prescribed dose of this drug in addition to cefaclor, ketoconazole, and medroxyprogesterone. Measured serum concentrations of terfenadine and its main metabolite showed excessive levels of parent terfenadine and proportionately reduced concentrations of metabolite, suggesting inhibition of terfenadine metabolism. We believe that a drug interaction between terfenadine and ketoconazole resulted in the elevated terfenadine levels in plasma and in the cardiotoxicity previously seen only in cases of terfenadine overdose.     

药物性肝炎的再认识

目的：了解药物性肝炎的发病规律，加强药物性肝炎的防治。方法：对216例药物性肝炎的发病规律及临床特征进行分析。结果：药物性肝炎患者多有明确使用损肝药物史，多发生于服药后10天—45天，临床表现无特异性，药物性肝炎多发生于长期、联合使用有肝毒性的药物而又无肝功能监测的患者。结论：影响药物性肝炎的因素有药物的种类，持续用药时间，联合用药，医生对药物性肝炎的认识以及是否指导患者监测肝功能，出现肝损害后是否及时停药等。     

Hypocalcaemic chorea secondary to malabsorption

A patient presented with chorea and a recent history of Crohn's disease. Investigation revealed the cause of the chorea to be hypocalcaemia secondary to malabsorption. So far as is known there has been no previous report of hypocalcaemic chorea due to malabsorption.     

64例药品不良反应分析

目的了解我院药品不良反应（ADR）的发生情况及引发ADR的相关因素,促进合理用药。方法对我院临床药师2006—2007年期间收集的64例ADR报告进行统计、分类并分析。结果64例ADR中,由静脉用药引起的不良反应51例（占79．7％）,抗感染药引起的ADR居首位,占31．3％。临床表现以皮肤及附属器损伤最为常见,占总例次的23．6％。结论应加强药品不良反应监测及相关知识的宣传,避免或减少不良反应的发生。     

丙戊酸药物的肝毒性研究进展

丙戊酸(VPA)是广泛使用的一线抗癫痫药。虽然安全性已得到临床的认可,但仍有报道,少数病例可出现潜在致死性肝毒性不良反应。其发病率很低(约1/50000),2岁以下儿童、遗传性代谢缺陷或神经系统发育异常、多药治疗时其危险性较高。目前认为,抗癫痫药VPA的肝毒性最有可能是与它的代谢物4-ene-VPA的生物活化有关,许多学者相继以不同实验方法研究VPA肝毒性的发生机制和防治措施,取得一定的进展。本文就近几年本症的致病机制、临床表现及监测治疗等方面进行综述。     

Just allocation and team loyalty: a new virtue ethic for emergency medicine

When traditional virtue ethics is applied to clinical medicine, it often claims as its goal the good of the individual patient, and focuses on the dyadic relationship between one physician and one patient. An alternative model of virtue ethics, more appropriate to the practice of emergency medicine, will be outlined by this paper. This alternative model is based on the assumption that the appropriate goal of the practice of emergency medicine is a team approach to the medical wellbeing of individual patients, constrained by the wellbeing of the patient population served by a particular emergency department. By defining boundaries and using the key virtues of justice and team loyalty, this model fits emergency practice well and gives care givers the conceptual clarity to apply this model to various conflicts both within the department and with those outside the department.     

老年人心房纤颤27例临床分析

本文对27例老年人心房纤颤的病因、临床特点和治疗方法进行了分析。老年人房颤的主要病因是冠心病,多为阵发性,发作时心室率大多<100次/分,转复后往往有窦性心动过缓,且为间歇性。肺心病、风心病和心肌病引起的房颤多为慢性,发作时心室率多>100次/分,易合并心力衰竭。房颤发作时心室率过快或合并心力衰竭,宜用洋地黄类药物治疗。而心室率不快、症状不多者,无血流动力学改变者不必转复治疗。老年人房颤乙胺碘呋酮转复有效。