Postgraduate medical journal
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A patient with hypocalcaemia and hypomagnesaemia secondary to small bowel resection and malabsorption was treated with synthetic vitamin D analogue, 1-alpha hydroxy vitamin D3. A prompt rise in serum calcium concentration and some days later a smaller and transient rise in serum magnesium concentration was observed. These changes in extracellular fluid composition presumably resulted from enhanced calcium and magnesium absorption associated with vitamin D activity.
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Severe narcosis occurred in a patient with hypoparathyroidism given therapeutic doses of codeine phosphate.
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Growth hormone (GH), prolactin (PRL) and thyrotrophin (TSH) responses to thyrotrophin-releasing hormone (TRH) were studied in 15 insulin-dependent diabetic patients. Basal plasma GH levels were raised above 5 mu./l in 6 patients and following the injection of TRH there was a significant rise in plasma GH levels in 9. ⋯ Basal PRL and TSH levels were normal and rose normally in response to TRH. GH release may be qualitatively abnormal in some diabetics and any such loss of specificity of GH-releasing mechanisms would further contribute to the raised GH levels found in many diabetics which would be of importance if GH is a factor in the aetiology of diabetic microangiopathy.
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Bacterial pyomyositis is common in the tropids but is rare in temperate climates. A patient with aplastic anaemia who had never left the continental United States developed bacterial pyomyositis secondary to Staphylococcus aureus which responded to antibiotics and surgical drainage. Bacterial pyomyositis should be considered in the differential diagnosis of fever and myalgias in the immunocompromised patient.
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Comparative Study
Terminal care: evaluation of in-patient service at St Christopher's Hospice. Part I. Views of surviving spouse on effects of the service on the patient.
The surviving spouses of 34 patients who died of cancer at St Christopher's Hospice have been interviewed about 13 months after the patient's death. The information given is compared with that obtained from 34 spouses of patients dying from cancer in other hospitals and matched with the St Christopher's group. ⋯ None was said to have been upset by these and 66% were glad of them. Despite the frequency of deaths in the Hospice, patients at St Christopher's were no more likely to be thought to have been 'upset' by such events than patients elsewhere or to have found their interactions with other patients anything but helpful.