The Olympus S1F small intestinal fiberscope type B may lose its hood.
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Biomedical subjects
Publications and source records attributed to H Freeman.
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During a 15-month period, 47 elderly female patients admitted to hospital with a fractured neck of femur were studied immediately prior to discharge, in comparison with 34 elderly female control patients undergoing elective surgery who had been admitted over the same period to the same orthopaedic wards. The principal differences between the two populations were that the fracture patients had a lower forearm trabecular bone density, with lower bodyweight (both lower muscle mass and lower fat content), increased body sway, worse eyesight and reduced mental acuity. The serum biochemistry of the two groups was almost indistinguishable except that the fracture patients tended to have slightly lower concentrations of proteins. There was no evidence to implicate dietary vitamin D deficiency, osteomalacia, oestrogen deficiency or alcoholism in the aetiology of the fracture, nor was there evidence to suggest alterations in endocrine function with respect to cacitonin or parathyroid hormone.
Fabry's disease is a rare, sex-linked disorder of glycolipid metabolism. We describe a patient with watery diarrhea, early satiety, and asymptomatic cholelithiasis. The jejunal aspirate demonstrated bacterial overgrowth; sigmoidoscopy showed rectal angiokeratoma corpora diffusum. The gastric emptying rate measured with 99mTc-sulfur colloid was markedly prolonged and the fasting gastrin was elevated at 276 pg/ml. The (14C)glycocholate breath test demonstrated a markedly elevated peak at 4 h, associated with an increased fecal bile acid loss of 0.82 g/day. Oral cholecystogram showed a solitary radiolucent stone in a functioning gallbladder. The bile acid pool size and lithogenic index were normal. Light microscopy of small bowel and rectal biopsy specimens revealed normal surface epithelium, but enlarged and vacuolated ganglion cells in Meissner's plexus. Electron microscopy showed laminated and amorphous osmiophilic deposits within ganglion cells of the submucosal plexus, within smooth muscle cells of the muscularis mucosae, and within endothelial cells lining arterioles, venules, and capillaries, but not in autonomic nerve fibers or enterocytes. The diarrhea and early satiety responded promptly to metoclopramide and to tetracycline. The early satiety was likely on the basis of delayed gastric emptying due to deposition of sphingolipid within ganglion cells of the autonomic nervous system; the diarrhea was likely on the basis of intestinal stasis with bacterial overgrowth and bile salt wastage.
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A trial was carried out over twelve months of a method for monitoring the care of a large number of schizophrenic patients in the community. The method has been demonstrated to be practical in use, economical of resources and potentially relevant to a number of chronic disorders.
A sample of chronic schizophrenic patients from an urban community, living outside hospital, were reassessed on the Present State Examination one year after a first examination. During this time their use of psychiatric hospital services was recorded. One hundred and two patients had satisfactory interviews on both occasions. These could be divided into Heavy, Medium and Light users of services, the numbers being 8, 14 and 63 respectively, while 17 only saw their general practitioners or had no treatment. A ranking of the sample in terms of severity showed no correlation with use of these services; second PSE scores were not significantly different from the first. Heavy and Medium users of hospital services were in contact with Social Services to a significantly greater extent than other patients.
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The 2-year experience of a foster home program for retarded children illuminates the problems of administration, staff and foster parents in preparing retardates to return to community life. The report on the experiment is hopeful.
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