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Biomedical subjects

R Hampshire

Publications and source records attributed to R Hampshire.

7 recordsLinked to original sources
PubMed1985

Whose hysteria: Briquet's, Janet's or Freud's?

Somatisation disorder (Briquet's syndrome) is a recent addition to psychiatric nosology. It represents an attempt to describe a syndrome of 'hysteria', the term initially applied to this polysymptomatic disorder by Guze and his colleagues. The manner of identification of this syndrome, however, has been the subject of criticism. This brief review suggests that the ideas of Janet, who worked at Salpetriere 30 to 40 years after Briquet, may provide a more precise approach to diagnosis. Furthermore, his hypotheses about predisposition to this disorder are seen to offer a preliminary way towards its understanding. Recent experimental evidence lends some support to Janet's hypotheses.

Conversion Disorder↗
PubMed1984

Convergence insufficiency in patients taking medicines.

The incidence of convergence insufficiency in patients taking medicines is compared with its incidence in patients taking no therapeutic drugs, in a sample of 648 taken from a normal optometric practice. It is found that the incidence was significantly higher in those patients on medicines considering the group as a whole. It is also found to be higher in older patients, and that most of the older patients were taking medicines whilst the younger patients were not. However, the increase in the incidence of convergence insufficiency in the older patients taking medicines was disproportionately high. It is concluded that age is not the only factor in the increased incidence, and that the taking of medicines as a possible indicator of poor general health, is also an important factor in the cause of convergence difficulties.

Age Factors↗
PubMed1982

Osteomalacia, vitamin D deficiency and cholestasis in chronic liver disease.

Twenty-nine patients with chronic liver disease, nine of whom had symptoms suggesting bone disease, were studied by bone histology. Nine had osteomalacia; six associated with cholestatic liver disease and three with primarily hepatocellular disease. Two of these had clinical and biochemical features of cholestasis for at least a year and the other had alcoholic cirrhosis associated with severe malnutrition. Excluding the latter patient, histological osteomalacia was significantly associated with presence and duration of cholestasis. Plasma 25-hydroxyvitamin D was low and fasting urine hydroxyproline/creatinine ratio was high in all patients with osteomalacia but were abnormal also in some patients who did not have histological osteomalacia. Serum calcium, phosphate, alkaline phosphatase, vitamin D-binding protein and radiology were unhelpful in many patients with osteomalacia. Vitamin D-deficiency correlated significantly with deficiency of other fat-soluble vitamins and those patients with rachitic levels of plasma 25-hydroxyvitamin D showed no seasonal variation, suggesting a combination of malabsorption of vitamin D and reduced sunlight exposure. We suggest that patients with chronic liver disease with cholestasis for at least a year are at risk from osteomalacia and that those likely to have this complication may be identified by plasma 25-hydroxyvitamin D and/or fasting urine hydroxyproline/creatinine ratio measurements. The diagnosis can only be made with certainty by bone biopsy.

25-Hydroxyvitamin D 2↗
PubMed1981

Evidence for secondary hyperparathyroidism in the osteomalacia associated with chronic liver disease.

Previous reports have suggested that secondary hyperparathyroidism is extremely uncommon in hepatic osteomalacia. This, together with other findings, has led to suggestions that in chronic liver disease there may be selective resistance of bone to vitamin D or a specific bone mineralization defect unrelated to Vitamin D. To examine these possibilities, twenty-five patients with chronic liver disease have been studied by bone biopsy, serum calcium and inorganic phosphate, plasma 25-hydroxyvitamin D, plasma immunoreactive parathormone (iPTH), fasting urine cAMP, fasting renal tubular maximal reabsorptive capacity for phosphate (TmP/GFR) and fine grain hand x-rays. Nine of the patients had osteomalacia on bone biopsy, eight of these had subnormal levels of plasma 25-hydroxyvitamin D and the other had a borderline result. Based on the consensus of all the tests, five of these had evidence of secondary hyperparathyroidism. Plasma iPTH was higher in patients with osteomalacia than in patients without osteomalacia (P less than 0.01) or controls (P less than 0.01). Urine cAMP was higher in patients with osteomalacia than in patients without osteomalacia (P less than 0.001) or controls (P less than 0.01). TmP/GFR was significantly lower in patients with osteomalacia than in controls (P less than 0.05) but not significantly different from patients without osteomalacia. The findings of this study indicate that hyperparathyroidism occurs in a substantial proportion of patients with the osteomalacia of chronic liver disease. Moreover, osteomalacia in chronic liver disease is clearly related to reduced levels of plasma 25-hydroxyvitamin D. We conclude that hepatic osteomalacia is a vitamin D deficiency state and there is no need to suggest an unusual aetiology.

25-Hydroxyvitamin D 2↗