Whole body MR imaging in ankylosing spondylitis: a descriptive pilot study in patients with suspected early and active confirmed ankylosing spondylitis

Background  

Ankylosing spondylitis is a chronic inflammatory rheumatic disorder which usually begins in early adulthood. The diagnosis is often delayed by many years. MR imaging has become the preferred imaging method for detection of early inflammation of the axial skeleton in ankylosing spondylitis.     

PARENTERAL THIAMINE AND WERNICKE'S ENCEPHALOPATHY: THE BALANCE OF RISKS AND PERCEPTION OF CONCERN

Wernicke's encephalopathy, a disorder with significant mortalityand high morbidity, is common amongst alcohol-dependent patients.Thiamine deficiency appears to play a key role in its aetiology,and parenteral high-dose thiamine is effective in prophylaxisand treatment. Unfortunately, reports of rare anaphylactoidreactions have led to a dramatic reduction in the use of parenteralthiamine, and it is possible that this change in treatment hasled, or will lead, to an increase in morbidity and mortality.There is a need for education of doctors who treat alcohol-dependentpatients, in order to ensure appropriate use of parenteral thiaminein prophylaxis and treatment of this disorder.     

Enteral versus parenteral nutritional support in acute pancreatitis: A clinical review

Abstract   A critical analysis of the trials comparing enteral with parenteral nutritional support in acute pancreatitis is presented with particular scrutiny of the clinical endpoints in each trial. The heterogeneity of the trials and the discrepancies in caloric intake between enterally and parenterally fed patients are discussed. The hazards of each route of nutritional support are highlighted and the concept of 'nutritional bioavailability' in the context of acute pancreatitis is introduced. It is concluded that although there is evidence to support enteral feeding as the preferred option, both routes have a role.     

A survey of forensic psychologists’ work with sex offenders in England and Wales

This paper describes the results of a survey of the extent and variety of work with sex offenders by psychologists working in different forensic settings in England and Wales. A postal questionnaire was sent out to all 199 psychologists in the special hospitals, regional forensic psychiatry services, prisons and youth treatment service requesting details about their work with sex offenders during the year June 1991 to July 1992. The results are described under the headings of assessment and treatment; supervision, consultation, teaching and training; research and evaluation. The discussion highlights some of the patterns and trends of the work of forensic psychologists with sex offenders, together with the range of psychological interventions. There are also patterns within services. Results of the survey highlight the links psychologists have with other disciplines in working with sex offenders and raise questions about the most appropriate model of psychology practice, given the limited resources.     

Effect of inhaled atrial natriuretic peptide on methacholine bronchoconstriction in asthma

We have previously demonstrated that intravenous and inhaled atrial natriuretic peptide (ANP) significantly inhibits histamine induced bronchoconstriction in asthmatic patients. The current study was designed to determine whether inhaled ANP was also able to inhibit the effects of methacholine. Eight atopic asthmatic patients (five women) were studied: mean (SD) age 38.2 (8.3) years flow expiratory volume per second (FEV₁) 2.97 (0.60) litres, equivalent to 92 (13) % of the predicted. Each had demonstrated at least mild bronchial hyperreactivity to inhaled methacholine at screening (geometric mean PC20 l.02mg/ml; range 0.1l–6.54mg/ml). Patients attended for 3 study days and after baseline spirometry received 3.5 ml saline (placebo), 0.1 mg ANP or 1 mg ANP (ANP dissolved in 3.5ml saline) in a randomized, double-blind manner via a Mizer aerosol conservation device. Aerosolization took approximately 9 min and FEV₁ was repeated at 0.5, 1.5 and 3 min after completion. Immediately thereafter each patient received a 2 min inhalation of methacholine at a dose individually calculated to give a 25% fall in FEV₁ (as extrapolated at their initial screening visit) and the FEY₁ was followed over the next 20 min. Mean (SEM)% FEV₁ did not change significantly after ANP being -4.3 (1.7), -3.2 (2.7) and -2.4 (1.2) after placebo, 0.1 mg ANP and 1 mg ANP respectively. The mean (SEM) maximum fall in FEV₁ after methacholine was as follows: placebo 26.9 (5.7)%, 0-1 mg ANP 18.2 (4.3)% and 1.0mg 11.2(2 7)%, (P < 0.05 placebo vs 1 mg ANP). These results demonstrate that ANP offers significant protection against methacholine induced bronchoconstriction in asthmatic patients.     

COMPARISON OF PIROXICAM WITH PLACEBO IN THE MANAGEMENT OF PAIN AFTER TOTAL HIP REPLACEMENT

A randomized double-blind controlled study was undertaken toassess the analgesic efficacy of piroxicam. Twenty-four patientsunderwent total hip replacement under spinal anaesthetic; afteroperation, they received a 3-day course of either placebo (n= 12) or piroxicam (n = 12). Adequate analgesia was providedfor 48 h by a patient-controlled analgesia system deliveringmorphine. Patients receiving piroxicam required 50% less morphinethan the control group (38 mg compared with 76 mg (P < 0.002)).This technique was tolerated well and there were no significantside effects.