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It has been well known that the fasting therapy which was invented in Medical School of Tohoku University reveals an excellent effect upon various kinds of psychosomatic diseases, but its therapeutic mechanism and suitable indication are not yet explained completely. In order to corroborate these problems, this study was undertaken on 262 cases of psychosomatic diseases in the field of internal medicine. It is a complete fasting for 10 days with nothing by mouth except for drinking water, and 500 ml of parenteral fluid containing vitamins are administered intravenously every day. Absolute bed rest and self meditation are required in a closed individual room, and patients are not allowed to meet anyone but physicians and nurse in charge. The return to normal ordinary diet follows the order of fluid diet, soft diet and semiordinary diet during 5 days. In the period of the therapy, various clinical and laboratory examinations were carried out. Significance of these examinations consists in prediction of possible danger during the fasting period and elucidation of its therapeutic mechanism. Consequently, an outstanding efficacy rate of 87% with excellent prognosis was attained, and the following diseases were determined as suitable indication of this therapy; irritable colon, dysorexia nervosa, borderline hypertension, neurocirculatory asthenia, bronchial asthma, mild diabetes mellitus, obesity, lumbago without organic findings, conversion hysteria, various neurosis with somatic symptoms and masked depression. Possible mechanism of action of the therapy is that fasting acts as an extreme stress on the function of the autonomic nervous and endocrine systems, then it regulates the function of whole body including the brain, also it acts as one of the behaviour therapy for abnormal conditioning.
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PMID:Fasting therapy for psychosomatic diseases with special reference to its indication and therapeutic mechanism. 96 29

A case is described of extradural abscess following extradural injection of local anaesthetic and steroid for the management of chronic low back pain. The common signs and symptoms are reviewed, possible causes discussed and the association with diabetes stressed.
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PMID:Extradural abscess following local anaesthetic and steroid injection for chronic low back pain. 214 56

General Practitioners feel increasing pressure from Public Health authorities to evaluate their work but generally accept outcome indices such as morbidity and mortality are too far away from GP practices to allow direct evaluation conclusions. A simple instrument is needed to assess the evolution in the health status of the populations the GP serves. To design such an instrument we developed a short, inexpensive questionnaire, to be filled in by the GP, that covers as many fields of health care as possible and reflects as closely as possible the specific approach in family practice. To construct this instrument five Guttman scales were first developed that refer to the five frameworks of though that a general practitioner uses, and submitted them to a process of validation. A composite index (SAMI) was mathematically derived from these five scales; it proved to be a valid instrument for measuring health status. To field test the SAMI index, a prospective cohort study was carried out in two subpopulations, Belgians and migrants, consulting seven GP practices. The evolution of four reasons for encounter (low back pain, pregnancy, diabetes and epigastralgia) were monitored by means of the five scales and the SAMI index. The evaluative conclusion that, despite special efforts of the GPs, their approach to migrants has to be reconsidered, is drawn. Above all the field test has shown that the five measurement scales and the global SAMI index are valid instruments, of easy use in general practice, that allow to assess the global health status of patient populations and give opportunities for evaluation of PHC services.
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PMID:Assessment of patients' health status in family medicine. 215 53

Localized suppuration involving the spinal cord is uncommon. A case of spinal subdural empyema is reported. The patient is 54-year-old male who had been suffering a diabetes mellitus but did not receive any treatment. His initial symptom was lumbago. Then he noticed a palpitation and general malaise which made him visit a hospital. Because he did not show any improvement by a fluid therapy, he was transferred to our institute for the further evaluation. On admission, physical examination showed no abnormality. Blood pressure was 170/90 mmHg, heart rate 128/min. and body temperature 37.1 degrees C suggesting a septic shock state. Neurological examination revealed slight consciousness disturbance, mild tetraparesis and bilateral hypesthesia lower than the level of L3. Laboratory examination showed the elevated leukocyte count and fasting blood sugar and urine ketone body levels of 20,500/mm3, 257 mg/dl and 226 mg/dl respectively. Blood culture proved a septicemia of Streptococcus agalactiae afterwards. On the second day of admission, lumbar puncture revealed a purulent cerebrospinal fluid, though X-ray CT of lumbar spine did not confirm a diagnosis. Spinal magnetic resonance imaging (MRI) revealed a widespread abnormal intensity of the spinal canal from the level of Th11 to L4. On the T1-weighted image (TR 300 msec., TE 40 msec.), cerebrospinal fluid space was abnormally isointense. On the T2-weighted image (TR 2,000 msec., TE 80 msec.), subdural and cerebrospinal space was filled with an abnormal high-intense lesion especially on the ventral side. He developed semicoma due to hydrocephalus following a intraventricular empyema. He was also complicated disseminated intravascular coagulation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Spinal subdural empyema diagnosed by MRI and recovered by conservative treatment]. 257 46

A case of emphysematous pyelonephritis, xanthogranulomatous pyelonephritis histologically, is reported. A 49-year-old female patient was referred to our department from the department of internal medicine because abdominal ultrasonography demonstrated left renal swelling with gas echo. Computed tomographic scan showed much emphysema in the left kidney. Although aggressive treatment with broad spectrum antibiotics and immunoglobulin had been performed, subfever and left lumbago continued. Thereafter, she underwent left nephrectomy, and histological findings revealed xanthogranulomatous pyelonephritis. In the Japanese literature 27 cases of emphysematous pyelonephritis have been reported. Many cases are in middle-aged females and 85% of these cases complicated with diabetes mellitus. E. coli and Klebsiella was the main causative organism. The mortality of this disease was 26%. This report is the first case combined with xanthogranulomatous pyelonephritis in Japan. We recommend adequate chemotherapy and timely surgical treatment for good results.
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PMID:[A case of emphysematous pyelonephritis combined with xanthogranulomatous pyelonephritis]. 273 41

This study examines the relationship between MMPI scales and functional limitation for the chronic illness populations of chronic low back pain, migraine headache, hypertension and diabetes. Average MMPI profiles for these groups approximate those of previous studies with the chronic low back group having the most disturbed profile and showing elevations especially on the Hs, Hy and D scales. Several kinds of analyses, however, demonstrate that, in general, the MMPI group differences can be accounted for by individual self-rated functional limitation. The data do not support attempts at defining a low back pain or chronic pain personality profile apart from the emotional disturbance associated with chronic limitation and disruption of activity.
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PMID:Does the MMPI differentiate chronic illness from chronic pain? 621 8

In order ot clarify the working conditions and health of dry cleaning workers, we investigated dry cleaning workshops in C ward of Nagoya City. We had the responses from 52 (91%) workshops and 181 (97%) workers. 26 (50%) of the workshops used petroleum solvents, 23 (46%) perchloroethylene, two (4%) 1, 1, 2-trichloro-1, 2, 2-trifluoroethane (R 113), and one (2%) petroleum solvent plus perchloroethylene. Average amounts of solvents consumed per workshop were 1280 kg/year of petroleum solvents, 1450 kg/year of perchloroethylene, and 275 kg/year of R 113. Average number of workers employed in 19 workshops per workshop was 3.6 persons (median 2.0), and the remaining 33(63%) workshops had no employee. The workers complained of strange smell, irritation of eyes, unsteady feeling of head at high rate during week. They also had the high rate of complaints of shoulder stiffness, fatigability, lumbago, and the percentages of them were higher in the workers using petroleum solvents than those in the workers using perchloroethylene. More detailed surveys were made in 13 workshops out of 52. In these cases, average working hours were 11.1 per day and average years of using solvents were 12.9 in workshops using petroleum solvents, 8.4 in those using perchloroethylene including 3.1 years of petroleum solvents. Relatively high concentrations of solvents were detected under the nose of the workers pulling clothes out of dry cleaning machines, near the clothes just pulled out, and about 30 cm above the clothes at brushing with solvents before putting them into the machines. Perchloroethylene leaked from the dry cleaning machine in a workshop. Amount of the total trichlorinated compounds (TTC) in the urine of the workers directly engaged in dry cleaning with perchloroethylene tended to be larger than those of the indirect workers. TTC in both groups, however, were significantly larger than those in the control and in the workers using petroleum solvents. RBC, Hb, an Ht of the female workers in the petroleum solvents workshops were lower than those in perchloroethylene workshops. Liver function tests showed that the average values in the workers directly engaged in dry cleaning with perchloreothylene were significantly larger than those in the indirect workers. A case of malignant lymphoma, a case of liver dysfunction and a case of diabetes mellitus were found among workers directly engaged in dry cleaning. Workers in the small-sized dry cleaning workshops would not be prevented from exposure to organic solvents without the further improvement of administrative guidance and cooperation of the makers of dry cleaning machines and solvents.
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PMID:[An occupational health survey on dry cleaning workers (author's transl)]. 732 Dec 86

Stiff-man syndrome is a rare neurologic disorder characterized by progressive, fluctuating muscle rigidity with painful muscle contractions affecting predominantly the back and proximal extremities. In the ED, the diagnosis can be easily overlooked and misdiagnosed as acute or chronic low back pain and muscle spasm. This syndrome is often associated with diabetes, autoimmune diseases, and cancer. This report describes an illustrative case of a 39-year-old woman who presented to the ED with a two-year history of right leg spasms and low back pain that had become so severe in the preceding two days that she was unable to ambulate. Clues to the patient's proper diagnosis coincide with the diagnostic criteria for stiff-man syndrome: the presence of a slowly progressive stiffness of the axial muscles and proximal limb muscles, making ambulation difficult; hyperlordosis of the lumbar spine; episodic spasms precipitated by jarring or sudden movement; a normal intellectual, sensory, and motor examination when not in spasm; and a marked amelioration of symptoms with the IV administration of diazepam. High-dose oral diazepam is the maintenance drug of choice.
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PMID:Stiff-man syndrome: case report. 758 54

Corticosteroids are extensively prescribed in advanced cancer for various specific indications (e.g. spinal cord compression), for pain relief, as hormone therapy and to stimulate appetite and wellbeing. Choice of corticosteroid is dictated largely by local fashion, and times of administration are more traditional than pharmacological. Corticosteroids have many potential disadvantages, some life-threatening (e.g. masked septicaemia). Others are seriously debilitating (e.g. myopathy, avascular bone necrosis). Oropharyngeal candidiasis is a common complication. Corticosteroids are withdrawn in about 5% of patients because of unacceptable adverse effects, including moon-face and diabetes mellitus. Corticosteroid hypersensitivity occurs, and the succinate salts have been associated with bronchospasm. Steroid pseudorheumatism may occur with high dose therapy or when tailing off after a prolonged course. Important drug interactions with corticosteroids relate to salt and water retention, and decreased glucose tolerance. Some anticonvulsants cause an increased clearance of corticosteroids and, with dexamethasone, up to a 50% reduction in the anticipated effect. The benefit of corticosteroids in terms of increased appetite, mood and activity has been demonstrated in several controlled trials. The effect may well be time-limited in most patients. In several studies, corticosteroids have resulted in an analgesic-sparing effect. Some centres use very high doses of dexamethasone in cases of spinal cord compression, although the justification for these is not obvious. Corticosteroids are used to help relieve nerve compression pain and in symptomatic raised intracranial pressure. Corticosteroids are also injected locally into or around bone metastases, particularly ribs and the sacro-iliac joints. Epidural injections are used for patients with troublesome intractable low back pain. Corticosteroids are now used less often in hypercalcaemia because of poor response rates. More benefit is obtained, however, if high dosages are used, e.g. prednisolone 60 to 80 mg/day. Dexamethasone is widely used as an antiemetic in association with chemotherapy. Some centres use dexamethasone by continuous subcutaneous infusion in selected patients when the oral route is not feasible. The choice of starting dose of a corticosteroid is largely arbitrary. It is important, however, not to miss a possible treatment benefit by prescribing too low a dose. For most patients, an initial dosage of prednisolone of 30 to 60 mg/day (dexamethasone 4 to 8 mg/day) is appropriate. In patients with anorexia, there are several alternative options that should be considered. There is evidence to suggest that patients with advanced cancer receiving a corticosteroid are not as closely monitored as other patients. There is a need to state clearly in writing the reason(s) for prescription and to review after 1 or 2 weeks.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:The risks and benefits of corticosteroids in advanced cancer. 781 99

We report the findings of a total population survey of Thugbah community in the Eastern Province of Saudi Arabia (SA) to determine its point prevalence of neurological diseases. During this two-phase door-to-door study, all Saudi nationals living in Thugbah were first screened by trained interviewers using a pretested questionnaire (sensitivity 98%, specificity 89%) administered at a face-to-face interview. Individuals with abnormal responses were then evaluated by a neurologist using specific guidelines and defined diagnostic criteria to document neurological disease. The questionnaire was readministered blind by a neurologist to all those with abnormal responses and a 1-in-20 random sample of those without abnormal responses, respectively. The family members of an individual with an abnormal response were also screened to improve accuracy. A total of 23,227 Saudis (98% of the eligible subjects) were screened and those residing in Thugbah on the reference date (22,630) were used to calculate the point prevalence rates. Forty-two percent of those screened were in the first decade of life and only 1.5% were more than 60 years old. There were marginally more females (50.2%) than males (49.8%). Consanguineous marriages especially between first cousins were present in 54.6%. The demographic characteristics of Thugbah community were similar to those in other parts of SA. The overall crude prevalence ratio (PR) for all forms of neurological disease was 131/1,000 population. All subsequent PRs are per 1,000 population. Headache syndromes were the most prevalent disorder (PR 20.7). The PR for all seizure disorders was 7.60, and the epilepsies (6.54) were more frequent than febrile convulsions (0.84). Mental retardation, cerebral palsy syndrome, and microcephaly were common pediatric problems with PRs of 6.27, 5.30 and 1.99, respectively. Stroke, Parkinson's disease, and Alzheimer's disease were uncommon with respective PRs of 1.8, 0.27 and 0.22. Central nervous system (CNS) malformations (0.49) such as hydrocephalus and meningomyelocele were more prevalent than spinal muscular atrophy (0.13), congenital brachial palsy (0.13) and narcolepsy (0.04). Multiple sclerosis was rare (0.04). Osteoarthritis and low back pain syndromes were the main non-neurological conditions seen. The major medical diseases that may be neurologically relevant were diabetes mellitus, hypertension, and connective tissue disorders.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:A community survey of neurological disorders in Saudi Arabia: the Thugbah study. 827 77


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