Articular mastocytosis in rheumatoid arthritis.

The number and distribution of mast cells were assessed in 116 synovial membranes from patients with rheumatoid arthritis and in 30 control specimens. Rheumatoid synovial membranes contained a mean of 48.5 mast cells per 20 high-power fields (HPF) (range 0-252), and control synovial membranes had a mean of 3.

Anorexia nervosa in Down's syndrome--a case report.

A case is described of anorexia nervosa arising in a mentally-handicapped 35-year old person with Down's syndrome. The late onset is accounted for on the grounds that adolescent challenges had only recently arisen in this instance. Removal of the patient from the provocative situation, coupled with some effective psychotherapeutic 'grief work' with the family, was associated with restoration of normal body weight and menstrual function, following the patient's acceptance of the usual re-feeding treatment programme.

Heparin modulates intracellular cyclic AMP in human trabecular bone cells and adherent rheumatoid synovial cells.

Cells were cultured from explants of human trabecular bone excised from eight patients and incubated usually for 20 minutes with bovine parathyroid hormone, salmon calcitonin, prostaglandin E2, or heparin. The intracellular content of cyclic AMP was measured by radioimmunoassay and was significantly increased by parathyroid hormone in four, by calcitonin in two, by prostaglandin E2 in eight, and by heparin in seven out of eight cultures. In the two cultures containing calcitonin-responsive cells heparin inhibited the cyclic AMP response induced by calcitonin.

Effect of intraluminal hydrocortisone on solute and water absorption in the human jejunum.

To compare the effects of intravenous and intraluminal hydrocortisone on jejunal transport, the proximal jejunum was perfused with glucose (28 mmol/l) in saline in two groups of normal subjects. In the first group of seven subjects, compared with the control period results there were no changes in sodium, water and glucose absorption during the intravenous administration of hydrocortisone. In contrast, intraluminal hydrocortisone (100 mg/l) increased sodium, water and glucose absorption by 169%, 223% and 81% respectively (P less than 0.

Nocturnal activity and the enuresis alarm device.

The effect on nocturnal activity of the wire mesh element within the 'buzzer and pad' enuresis alarm device was studied using healthy adult volunteers in a single or double cross-over design. On the nights when the mesh was in the bed there was less activity, supporting the finding of improved polygraphic sleep on the mesh and suggesting an unexpected therapeutic mechanism.

Myocardial infarction and the emotional climate.

Within the general population people destined for myocardial infarction are found to be more obsessional and greater worriers than others. Moreover, in the year before their infarction they display high levels of sadness, anxiety-related symptoms, loss of libido, and fatigue, unrelated to angina and other physical discomforts. They also claim, more so than others, to have no fear of having an incurable illness.

A future pattern of psychiatric services and its educational implications: some suggestions.

Psychiatry has expanded rapidly as a medical discipline in the last two decades but has not always been able to recruit sufficient young doctors of ability to its ranks. In view of recent governmental and professional reports on future medical practice we set up a study group comprising members from academic, NHS, sub-specialty, community and in-training psychiatry to examine the present tasks, attractions and constraints within a career in psychiatry and propose possible improvements for further consideration. In marrying these views to foreseeable developments we are sensitive to the requirement to take into account both the needs of the community and the job satisfaction of the future psychiatrist.

Combined treatment of post-menopausal osteoporosis: effect on muscle function and a new radiological method for assessing trabecular bone.

Ten women presenting with at least two osteoporotic vertebral crush fractures were treated with alfacalcidol (one-alpha-hydroxycholecalciferol), calcium lactogluconate, oestrogen and progestagen for 6 months. Significant improvements in the patient's assessment of pain, grip strength, walking and stair climbing times were found. These suggest that a sub-clinical myopathy may be a feature of osteoporosis.

Studies of histamine in the rheumatoid joint.

Fragments of synovial membranes from three patients with rheumatoid arthritis were incubated in Dulbecco's modified Eagle's medium (DMEM). Histamine was released into the medium at rates up to 649.3 ng/g synovium/day.

beta 2 microglobulin plasma levels reflect disease activity in rheumatoid arthritis.

Elevated plasma levels of beta 2 microglobulin have been described in rheumatoid arthritis (RA) but their relationship to disease activity is unclear. In patients treated for 6 months with auranofin (AF) there was a significant fall (p less than 0.05) in beta 2M levels pari passu with improvement in disease activity as measured by a fall in C-reactive protein.

Failure of sodium aurothiomalate and triethyl phosphine gold to cause renal tubular injury in rheumatoid arthritis: implications for the aetiology of gold-related nephropathy.

The urinary excretion of two proteins, B-2-microglobulin (beta 2M) and N-acetyl-B-D-glucosaminidase (NAG) was measured in 25 patients with rheumatoid arthritis (RA) on nonsteroidal anti-inflammatory drugs (NSAID). Although beta 2M excretion was normal NAG excretion was raised. As NAG excretion by a group of osteoarthritis patients receiving similar doses of NSAIDs was normal, it is concluded that rheumatoid disease per se may be associated with mild renal tubular dysfunction.

Reproductive hormone changes during weight gain in male anorectics.

Plasma LH, FSH, testosterone and sex-hormone-binding globulin have been measured in a total of ten male anorectics. There was no significant correlation between body weight and FSH levels or body weight and SHBG levels. Both LH and testosterone concentrations were significantly correlated with body weight.

Constrictive pericarditis and intestinal haemorrhage due to Whipple's disease.

Two months after a pericardectomy for constrictive pericarditis a 37-year-old man presented with diarrhoea, abdominal pain and weight loss. During the course of investigation he developed brisk rectal bleeding and emergency angiography revealed a bleeding site related to an area of abnormal vasculature in the caecum. At laparotomy, the small bowel was found to be inflamed and the mesenteric lymph nodes enlarged.

The effect of hyperparathyroidism on the course of rheumatoid arthritis.

Rheumatoid arthritis and primary hyperparathyroidism have been diagnosed in three patients. This is likely to represent the coincidence of two common diseases but the clinical features are discussed with particular reference to the presence and withdrawal of raised levels of circulating parathyroid hormone (PTH). It is argued that raised levels of PTH potentiate the effects of the rheumatoid disease on bone and joints.

Sleep and the enuresis alarm device.

The effect on sleep of the wire-mesh element within the `buzzer and pad' enuresis alarm device was studied using healthy adult volunteers in a single or double crossover design. Polygraphic recording revealed a reduction in the number of shifts between sleep stages, and in the time spent in wakefulness, movement and stage 1, on the nights when the mesh was in the bed. This effect may be responsible for preventing some of the enuretic episodes which would otherwise have occurred at such times.