SummaryA 39-year-old female patient who had been receiving 30 mg of baclofen daily for 5 months was admitted to the hospital about 12 hr after an overdose of this drug (450 mg). On admission, she was comatose, flaccid, and in respiratory failure. Later she developed muscle twitchings and had several epileptic fits. She was treated symptomatically and became conscious within 36 hr. However, approximately 65 hr after the overdose she developed sinus tachycardia which was successfully treated with oral propranolol. Plasma concentrations, as measured on days 2 and 3, were within the therapeutic range but the elimination half-life was prolonged.
Seventy-seven of 84 surviving patients in whom the irritable bowel syndrome had been diagnosed at least six years previously were reviewed. A different diagnosis was made in only four cases. Forty-four patients remained symptomatic and 29 patients had no further bowel problems.The irritable bowel syndrome is often a chronic, relapsing disorder, and further investigations are not necessary unless symptoms change considerably.
The contribution of the elderly to the workload of a combined consultative District Hospital Gastroenterology Clinic has been studied over a 12-year period. The elderly group comprise 24% of the total referrals with a gradually increasing trend over successive years. The service implications are discussed and the main diagnostic categories reviewed. Particular attention is drawn to the low incidence of functional gastroenterological disorders in the elderly and the corollary that there is a high chance of an organic explanation for the presenting complaints.
The surgical aspects of 12 years' involvement with a combined consultative gastroenterology clinic at a district general hospital are reviewed. In this time the overall number of patients subjected to surgery has gradually fallen and the average age of patient referral has gradually increased and the logistical implications are considered. Trends for the common diagnoses encountered are discussed and the educational benefit of the clinic is stressed.
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