An imaging study of parkinsonism among African-Caribbean and Indian London communities.

We previously reported on 131 parkinsonian patients of African-Caribbean and Indian origin attending movement disorders clinics in six London Hospitals, of whom approximately 20% manifested atypical parkinsonism with a late-onset, akinetic-rigid predominant syndrome, postural instability and minimal resting tremor refractory to levodopa therapy and dopamine agonists (see Hu et al., Neurology 2000;54[Suppl.3]: A188 and Hu et al.

D90A-SOD1 mediated amyotrophic lateral sclerosis: a single founder for all cases with evidence for a Cis-acting disease modifier in the recessive haplotype.

More than 100 different heterozygous mutations in copper/zinc superoxide dismutase (SOD1) have been found in patients with amyotrophic lateral sclerosis (ALS), a fatal neurodegenerative disease. Uniquely, D90A-SOD1 has been identified in recessive, dominant and apparently sporadic pedigrees. The phenotype of homozygotes is stereotyped with an extended survival, whereas that of affected heterozygotes varies.

The neuroendocrinology of chronic fatigue syndrome and fibromyalgia.

Background: Disturbance of the HPA axis may be important in the pathophysiology of chronic fatigue syndrome (CFS) and fibromyalgia. Symptoms may be due to: (1) low circulating cortisol; (2) disturbance of central neurotransmitters; or (3) disturbance of the relationship between cortisol and central neurotransmitter function. Accumulating evidence of the complex relationship between cortisol and 5-HT function, make some form of hypothesis (3) most likely.

How many functional somatic syndromes?

Objective: Patients with medically unexplained symptoms are given diagnoses dependent upon the particular medical specialty consulted--irritable bowel syndrome in gastroenterology, fibromyalgia in rheumatology and others. The purpose of this paper is to establish whether these 13 different syndromes are discrete entities.

Methods: Consecutive new patients in seven outpatient clinics at two general hospitals were recruited.

Magnetic resonance markers of ischaemia: their correlation with vasodilatory reserve in patients with carotid artery stenosis and occlusion.

Objectives: Better methods of identifying patients with asymptomatic carotid artery stenosis who are at high risk of stroke are required. It has been suggested that proton magnetic resonance spectroscopy (MRS) may allow the identification of ongoing ischaemia in this patient group by the detection of a potentially reversible reduction of N-acetyl aspartate (NAA), a presumed marker of neuronal integrity, and the presence of lactate, a marker of anaerobic metabolism. Previous studies have reported metabolite ratios rather than absolute concentrations.

Urinary free cortisol in chronic fatigue syndrome.

Objective: The authors measured 24-hour urinary free cortisol in a group of well-characterized patients with chronic fatigue syndrome.

Method: They obtained 24-hour urine collections from 121 consecutive clinic patients with chronic fatigue syndrome and 64 comparison subjects without the syndrome.

Results: Urinary free cortisol was significantly lower in the subjects with chronic fatigue syndrome regardless of the presence or absence of current or past comorbid psychiatric illness.

Extramotor involvement in ALS: PET studies with the GABA(A) ligand [(11)C]flumazenil.

We used the benzodiazepine GABA(A) marker [(11)C] flumazenil to study cerebral dysfunction in amyotrophic lateral sclerosis (ALS) with PET. Seventeen non-demented patients with clinically definite or probable ALS were scanned and statistical parametric maps were derived to localize changes in regional flumazenil volumes of distribution (FMZVD), which correlate closely with receptor density (B(max)), and the results were compared with those of 17 controls. The ALS group showed statistically significant decreases in relative FMZVD in the prefrontal cortex (areas 9 and 10 bilaterally), parietal cortex (area 7 bilaterally), visual association cortex (area 18 bilaterally) and left motor/premotor cortex (including area 4) (P < 0.

The 1microg short Synacthen test in chronic fatigue syndrome.

Objective: Many studies suggest mild hypocortisolism in chronic fatigue syndrome (CFS), usually assumed to be due to reduced suprahypothalamic drive to the hypothalamo-pituitary-adrenal (HPA) axis. We wished to explore further the state of the HPA axis in CFS using the 1 microg low dose short Synacthen test.

Design: Subjects received an intravenous bolus of 1 microg Synacthen; samples for cortisol estimation were taken at baseline and 2, 10, 20, 30, 40 and 60 minutes after injection.

Psychosocial and developmental antecedents of chest pain in young adults.

Objective: The objective of this study was to assess the relationships among chest pain, psychiatric disorder, and early experience of ill health.

Methods: The Medical Research Council National Survey of Health and Development is a population-based birth cohort study established in 1946 (N = 5362). During childhood, several informants (parents, teachers, and school physicians) were interviewed or completed questionnaires.

Childhood risk factors for adults with medically unexplained symptoms: results from a national birth cohort study.

Objective: The purpose of this study was to test the hypothesis that the prior experience of physical illness in childhood is associated with later experience of medically unexplained symptoms.

Method: A nested case-control study was performed within a prospective birth cohort study: the Medical Research Council National Survey of Health and Development. The 5% most symptomatic individuals at age 36 years were identified and screened for physical illness.

Asymptomatic embolization predicts stroke and TIA risk in patients with carotid artery stenosis.

Background And Purpose: Improved methods of identifying patients at high risk of thromboembolism would allow improved targeting of therapy. One such situation is carotid artery stenosis. This is associated with an increased risk of stroke, which can be reduced by carotid endarterectomy.

Low-dose hydrocortisone in chronic fatigue syndrome: a randomised crossover trial.

Background: Reports of mild hypocortisolism in chronic fatigue syndrome led us to postulate that low-dose hydrocortisone therapy may be an effective treatment.

Methods: In a randomised crossover trial, we screened 218 patients with chronic fatigue. 32 patients met our strict criteria for chronic fatigue syndrome without co-morbid psychiatric disorder.