Journal of the Royal Society of Medicine

Thirty-five patients with chronic anal pain of obscure origin are described. This syndrome is ill-defined and treatment is unsatisfactory. There is a high incidence of sciatica and of damage to the pelvic floor musculature, but although the pain has features consistent with a neuralgia, its cause is unknown.

Musculoskeletal symptoms developing during the treatment of thyroid disease were studied in 150 patients; 17 developed a symptom complex of early morning stiffness together with shoulder girdle pain and weakness; similar symptoms were seen in only 3 of 100 controls. A prospective study of 16 patients with recent onset rheumatoid arthritis followed during the first 6 months of penicillamine therapy showed no changes in thyroid function tests. It is suggested that changing or abnormal thyroid status may precipitate or exacerbate musculoskeletal disease. Finally, in a retrospective study of 26 patients with both thyroid disease and rheumatoid arthritis, 4 patients had a simultaneous onset of both myxoedema and rheumatoid arthritis, the activity of which was greatly improved by correction of the hypothyroid state.

Repeated swallowing of foreign bodies, in adults, is part of a syndrome comprising personality disorder, drug overdose, and other self-inflicted injuries. The management should be conservative, as in many cases the foreign body will pass naturally or can be left in the bowel, if necessary for several years. Surgical intervention should be reserved for the complications of perforation, severe haemorrhage and persistent complete bowel obstruction, or for the removal of a toxic substance from the bowel. Five cases are reported which illustrate the natural history and management of the problem.

In a retrospective survey of 63 cases of inverted nipple, unaccompanied by a palpable mass, 3 histologically confirmed carcinomas were found on combined clinical and mamographic examination — an incidence of 5%. No carcinoma was found in those patients under 50 years of age. The problem of the false negative mammogram is discussed.

Three cases of pancreatic abscess are described to show the difficulties in diagnosis and that inadequate treatment is invariably fatal. Early recognition and prompt surgical drainage, together with biliary decompression if indicated, are advised.