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BRITISH MEDICAL JOURNAL VOLUME 289 29 SEPTEMBER 1984 799 few days later he noticed an area of numbness and paraesthesia below the right rib cage. These symptoms were more pronounced at night. A random blood glucose concentration was 12-3 mmol/l (221 mg/100 ml) and glycosylated haemoglobin 8°% (range in non-diabetics 5-7°%). Urea and electrolytes, serum Bl,, and results of liver function tests and urine analysis were normal. A Venereal Disease Research Laboratory test gave a negative result. Nerve conduction studies in the peroneal nerve were normal, though the sural nerve showed evidence of peripheral sensory neuropathy. Electromyography showed fibrillations and positive waves, an increase in the proportion of polyphasic motor unit potentials, and decreased interference patterns in the rectus abdominis innervated by T6-T12 on the right. Similar changes were seen in the right external oblique and thoracic paraspinal muscles. All studies on the left side gave normal results.Thoracic polyradiculopathy was diagnosed, and the sensory symptoms resolved over two months. No change was seen in the abdominal swelling. CommentThis patient presented with asymmetrical motor abnormalities in the abdominal muscles and mild and transient sensory symptoms affecting the right T6 and T7 dermatomes. He had electrophysiological evidence of only a mild sensory peripheral neuropathy, and, furthermore, there was no postural hypotension or clinical evidence of decreased sweating in the feet to suggest autonomic neuropathy. We could not perform standard heart rate dependent tests of autonomic function as the patient was in atrial fibrillation. Kikta et al reported on one patient with thoracic polyradiculopathy who was found to have abdominal swelling, though the patient was not diabetic and had an eight month history of abdominal pain. The diagnosis was confirmed by electromyography, and although a glucose tolerance test did not confirm diabetes it was suggestive of impaired glucose tolerance, which may have contributed to the aetiology of the polyradiculopathy.5Truncal polyradiculopathy should be considered in diabetic patients with unexplained abdominal pain or areas of muscle weakness. This case shows that such patients may present with no other neuropathic manifestations. If the diagnosis is considered early many unnecessary investigations might be avoided. Electromyography is the most helpful investigation in diagnosing this condition.3 5We thank Dr Jay Skyler for his encouragement. AJMB was supported in part by the Wellcome Foundation and Ayerst Laboratories. Accumulation of midazolam after repeated dosage in patients receiving mechanical ventilation in an intensive care unit Midazolam hydrochloride (Hypnovel) is a recently introduced imidazobenzodiazepine. Its potency and rapid onset and short duration of action after a single intravenous bolus make it an ideal agent for premedication or induction in anaesthesia for short surgical, endoscopic, and dental procedures. These same pharmacokinetic features would seem to make the dr...

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Nitrogen balance was determined in 48 patients who were entered into a randomized prospective double-blind study, comparing anabolic steroids versus placebo in our parenteral nutritional support system. The group included both young and old patients suffering from catabolic illnesses, in whom intravenous feeding ranged from 14-21 days. All participants received the active agent or placebo biweekly throughout the study. During the period of intravenous nutrition, there was statistically significant difference in nitrogen balance and protein conservation in the patients receiving the active agent.