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Spinal epidural abscess is a rare condition requiring prompt diagnosis and neurosurgical intervention if permanent neurological sequelae are be avoided. A patient is described who presented with meningism due to an acute spinal epidural abscess extending from the cervical to the lumbar region and which was managed non-operatively.

Relieving heartburn and healing esophagitis may appear to be primary aims in the management of gastroesophageal reflux disease, but systematic consideration of the issues demonstrates that there are discrepancies between the fundamental aims of medical management and the aims selected for study in trials of drug efficacy. The initial aims of management are those concerned with diagnosis, patient assessment and the provision of explanation and advice. The therapeutic objectives are alleviating symptoms, preventing complications and, if possible, avoiding recurrence, and should ideally be judged in terms of health gain, including quality of life improvement. Obtaining value for money, by maximizing the health gain in relation to the cost of the overall medical intervention must also be acknowledged as a desirable aim of management, with the proviso that physicians must always treat each patient as an individual and individualize clinical management appropriately.

Flunitrazepam or diazepam with atropine and a combination of phenoperidine, droperidol and cyclizine (neuroleptanalgesia) were compared as premedication in three groups of 25 patients undergoing routine upper gastrointestinal endoscopy. Drug doses were titrated carefully against response and all three regimes were found to be similar in terms of safety, patient co-operation, relaxation and speed of recovery. Neuroleptanalgesia however produced a statistically significant rise in endtidal pCO2 and systolic blood pressure. The benzodiazepines, and in particular flunitrazepam, produced a significantly greater amnesia for the procedure, patients given these drugs being more willing to undergo repeat endoscopy.