SummaryIn a retrospective survey of 34 patients with primary hyperparathyroidism (HPT), 18 (53%) complained of musculo-skeletal symptoms during the 12 months before the diagnosis was made and 9 (26%) attended at some time for either a rheumatological or orthopaedic consultation. Myalgia was the most frequently reported symptom which occurred in 41% of patients. Arthralgia, mainly affecting the large joints was present in 11 (32%) patients, 2 of whom had an erosive synovitis mimicking rheumatoid arthritis.Radiological abnormalities were seen in 8 patients. Clinicians should be aware of the variety and frequency of musculo-skeletal symptoms associated with HPT and should consider including serum calcium measurements when investigating rheumatic complaints.
Summary and conclusionsOut of 208 cases of coma of unknown aetiology referred to the poisons unit of this hospital during 1978 for emergency toxicological investigations, 108 were found to be due to self-poisoning. Medical conditions, mainly neurological, accounted for coma in 90 patients; the cause was not ascertained in the remaining 10 cases. More than one preparation had been ingested by 58 (54%) of the poisoned patients, although barbiturates were the drugs most commonly encountered in the severe cases.Toxicological investigations should be considered in the differential diagnosis of coma when history, physical examination, and emergency biochemical measurements yield little diagnostic information.
Significant depression of delayed cutaneous hypersensitivity (DCH) to seven common recall antigens was found in 50 patients with rheumatoid arthritis (RA) compared with 50 matched controls. Complete skin anergy was seen in 12 (24%) of the RA patients but in none of the control subjects. In addition, a nutritional assessment of all subjects tested showed significantly lower serum albumin and body mass indices in the RA compared with the control group. Analysis of these 100 subjects showed a significant correlation (r = 0.53, p less than 0.001) between the number of positive skin reactions and the concentration of serum albumin suggesting an association between nutritional status and DCH. No single factor could be identified to distinguish the reactive and anergic RA patients with the possible exception of drug treatment in that a higher proportion of patients on sodium aurothiomalate or immunosuppressive therapy than D-penicillamine was found in the anergic group. It is likely that the cause of impaired DCH in RA is multifactorial and our findings suggest that drug treatment and nutritional status may be an important contributor to it.
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