uhmc.sunysb.edu
A 52 yo lawyer was referred to your office because of difficulty swallowing his own saliva. He had been in his usual state of health until 3 months ago when he began to have difficulty swallowing. He first noticed the problem with liquids and was still able to eat solids and semi soft foods, however the problem had progressed to the point where he could not swallow any liquids including his own saliva. He carried a handkerchief with him and often sat with it just below his mouth catching the dripping saliva. He denied any other complaints, but when queried admitted that he tended to slur his words in the last few weeks. His physical examination was normal, but he could not swallow. He also had trouble carrying out rapid alternating movements of his tongue (”Say la, la, la,la…”) and palate (”Say.k, k, k, k, …”). His tongue appeared atrophied and had numerous obvious fasiculations on both sides. His deep tendon reflexes were 3+ throughout and his ankle reflexes were 4+ with unsustained clonus. A right Babinski sign was present. Plantar stimulation on the left was equivocal.
Questions:
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1)
What is the differential diagnoses and what test would you carry out to make the diagnosis?
2)
Name this syndrome. What group of diseases include it?
3)
Give at least two theories of the origin of this group of diseases. What is the evidence for each?
4)
What should be done for the patient and his family?
August 8th, 2006
The Herald - Aug 01 6:11 PM
PAUL ROGERSON
The man who presided over the breakneck expansion of Scotland’s biggest hotel group has left abruptly and without explanation.
Peter Gray, who was chief executive of Kent-based Swallow Hotels, led an acquisition spree which has seen the group take over nearly 40 hotels north of the border since the beginning of last year.
Alan Bowes, executive chairman of London and Edinburgh Swallow Group, insisted the company’s strategy to increase its Scottish portfolio from the current 70 hotels to 100 by 2007 is unaffected by Gray’s departure.
Gray, 46, was tightlipped when contacted at home, saying only: “There is no animosity. I left in very good circumstances. Everyone’s cool.”
In a statement, Bowes said last night: “I can confirm that Peter Gray has decided not to continue his role as Swallow Hotels’ chief executive.
“He has helped us build Swallow Hotels into the fastest-growing hotel chain in the UK and the largest in Scotland.
“After joining us three years ago, when we had just 13 hotels, he has successfully completed this role and has now decided to move on and pursue
ther interests.
“I would like to thank him for his considerable efforts, wishing him every success in the future.”
Bowes added: “Our future plans for Scotland remain the same and our operations director in Scotland, Tom Graham, will play a key part in taking these forward.
“We intend to build on our infrastructure and continue to support and grow our Scottish estate.”
Andrena Salter, a close confidante of Bowes whose remit was previously limited to Scotland, has been appointed executive operations director for the whole of the UK.
The man who presided over the breakneck expansion of Scotland’s biggest hotel group has left abruptly and without explanation.
Peter Gray, who was chief executive of Kent-based Swallow Hotels, led an acquisition spree which has seen the group take over nearly 40 hotels north of the border since the beginning of last year.
Alan Bowes, executive chairman of London and Edinburgh Swallow Group, insisted the company’s strategy to increase its Scottish portfolio from the current 70 hotels to 100 by 2007 is unaffected by Gray’s departure.
Gray, 46, was tightlipped when contacted at home, saying only: “There is no animosity. I left in very good circumstances. Everyone’s cool.”
In a statement, Bowes said last night: “I can confirm that Peter Gray has decided not to continue his role as Swallow Hotels’ chief executive.
“He has helped us build Swallow Hotels into the fastest-growing hotel chain in the UK and the largest in Scotland.
“After joining us three years ago, when we had just 13 hotels, he has successfully completed this role and has now decided to move on and pursue other interests.
“I would like to thank him for his considerable efforts, wishing him every success in the future.”
Bowes added: “Our future plans for Scotland remain the same and our operations director in Scotland, Tom Graham, will play a key part in taking these forward.
“We intend to build on our infrastructure and continue to support and grow our Scottish estate.”
Andrena Salter, a close confidante of Bowes whose remit was previously limited to Scotland, has been appointed executive operations director for the whole of the UK.
A spokeswoman for the company denied she is effectively Gray’s replacement.
Swallow has raised eyebrows in the industry with its aggressive business model. Bowes’ involvement dates from 2003 when his London Inn Group took control of 13 Swallow hotels from Whitbread in a £52m deal backed by property tycoon Leo Noé.
At the same time, LIG bought the rights to the Swallow brand name for £5m.
Swallow has since embarked on a rapid expansion programme which took its total portfoli
to about 140 UK hotels.
Gray has said Scotland’s disproportionate weighting comes from the fact that prices are cheaper than in other parts of the UK.
The Herald understands that the company has had the means to expand so quickly because freeholds are held not within the group, but by separate companies backed by wealthy individuals, investment syndicates and pension funds. Swallow leases the hotels.
Last summer, Bowes’ company took over 20 hotels from Edinburgh-based hotelier North British Trust Group.
In March this year, the company paid more than £20m for six more Scottish hotels, including well-known golfing and conference venues the Carnoustie Golf Hotel and Resort and the Gleddoch House Hotel and Country Estate at Langbank in Renfrewshire.
Bowes also made the news for different reasons in the spring when Swallow went to court in a legal challenge to Scotland’s smoking ban.
He sought a judicial review of the law, claiming that it breached human rights. He later dropped the challenge.
August 8th, 2006