ABSTRACT
OBJECTIVES: To review the management of a cohort of patients with positive treponemal serology and psychiatric and/or neurological disorders. METHODS: A retrospective case note review of 172 patients with positive treponemal serology attending the Patrick Clement's Clinic, Central Middlesex Hospital between December 1990 and November 1995 was performed. RESULTS: 101 men and 71 women were new attenders diagnosed with positive treponemal serology. A neurological problem was identified in 27 patients (12 women and 15 men) with psychiatric and/or neurological disorders, of whom 20 (six women and 14 men) underwent investigation of the cerebrospinal fluid (CSF). With the medical history and results of CSF-RPR and FTA tests, white cell count (WCC), and total protein level in the CSF, 10 patients (eight men and two women) were diagnosed with likely neurosyphilis and 17 with neurological disorders not thought to be caused by syphilis. The clinical features in those having neurosyphilis were sensorineural hearing loss (n = 5) and tabes dorsalis (n = 5). In the seven patients diagnosed with neurosyphilis who underwent CSF examination one patient had a reactive CSF-FTA, elevated protein, and elevated WCC; one patient had a reactive CSF-FTA and RPR with elevated protein; the total protein only was elevated in three cases and the WCC elevated in one case. Nine of the 10 patients with neurosyphilis received adequate neurosyphilitic treatment; one patient was lost to follow up. CONCLUSIONS: The management of patients with positive treponemal serology and psychiatric and/or neurological disorders was consistent. Patients with suspected neurosyphilis or patients with neurological signs compatible with neurosyphilis (who did not undergo CSF examination) were treated with adequate neurosyphilitic therapy.
Subject(s)
Neurosyphilis/diagnosis , Adult , Aged , Aged, 80 and over , Alzheimer Disease/ethnology , Alzheimer Disease/microbiology , Dementia, Multi-Infarct/ethnology , Dementia, Multi-Infarct/microbiology , Female , Hearing Loss, Sensorineural/ethnology , Hearing Loss, Sensorineural/microbiology , Humans , London/epidemiology , Male , Memory Disorders/ethnology , Memory Disorders/microbiology , Middle Aged , Neurosyphilis/cerebrospinal fluid , Neurosyphilis/therapy , Referral and Consultation , Retrospective Studies , Tabes Dorsalis/ethnology , Tabes Dorsalis/microbiology , West Indies/ethnologyABSTRACT
The authors present a case of dietary vitamin B12 deficiency in a patient with multiple sclerosis. A simple schemata for evaluating patients for vitamin B12 deficiency is included as a clinical aid for physicians.
Subject(s)
Feeding and Eating Disorders/complications , Multiple Sclerosis/complications , Vitamin B 12 Deficiency/etiology , Adult , Clinical Protocols , Decision Trees , Feeding and Eating Disorders/diagnosis , Feeding and Eating Disorders/psychology , Feeding and Eating Disorders/therapy , Humans , Male , Medical History Taking , Psychotherapy , Vitamin B 12/therapeutic use , Vitamin B 12 Deficiency/diagnosis , Vitamin B 12 Deficiency/therapyABSTRACT
Many methods have been described for correction of the "whistling lip" deformity, a possible sequela of bilateral cleft lip repair. A technique is described that utilizes medially based deepithelialized mucosal-submucosal flaps to augment the central tubercle and to reduce lateral lip fullness. This technique is also useful for certain mucosal contour defects that follow unilateral cleft lip repair. Indications for applying this technique and its advantages, compared with other procedures, are described.