Saccade and cognitive function in chronic kava users.

Kava is an extract from the Piper methysticum Forst. f. plant that has been consumed in the Pacific islands for millennia and more recently, among indigenous populations, in northern Australia and throughout the Western world as an herbal medicine. Through alterations on neuronal excitation, kava induces muscle relaxation, anasthesia, and has anxiolytic properties. There have been several isolated reports of psychotic syndromes, severe choreoathetosis and possible seizures following kava use. However, there is no conclusive evidence that kava interferes with normal cognitive processes. We tested a group of current, ex, and nonkava users among an indigenous population in northern Australia, using saccade and cognitive tests that have proven cross-cultural validity and are sensitive to subtle disruptions of the brain arising from substance abuse or neuropsychiatric illness. Despite collecting data from among the heaviest reported kava drinkers in the world, we found no impairment in cognitive or saccade function in individuals who were currently heavy kava users (and had been for up to 18 years), nor was there any impairment in individuals who had been heavy kava users in the past but had abstained for longer than 6 months. Current and ex-kava users showed a higher rate of kava dermopathy, lower body mass index, lowered blood lymphocytes and, in addition, current kava users showed elevated liver enzymes. While there has recently been increasing concern about potentially fatal liver damage attributed to kava use, we have found no evidence of brain dysfunction in heavy and long-term kava users.     

Percutaneous nephrostomy in gynecologic oncology

Percutaneous nephrostomy is a useful method of supravesical diversion when ureteral obstruction occurs at initial diagnosis of gynecologic cancer or recurrence of disease. Although survival is prolonged, the attendant quality of life would indicate that percutaneous nephrostomy should be performed only in those cases in which there is a reasonable chance for palliation or a hope for cure or when temporization is needed to define adequately the etiology of ureteral obstruction following therapy.     

New Orientia tsutsugamushi strain from scrub typhus in Australia.

In a recent case of scrub typhus in Australia, Orientia tsutsugamushi isolated from the patient''s blood was tested by sequence analysis of the 16S rDNA gene. The sequence showed a strain of O. tsutsugamushi that was quite different from the classic Karp, Kato, and Gilliam strains. The new strain has been designated Litchfield.     

Concurrence of multiple sclerosis and glioma

Three cases are reported of concurrence of malignant gliomas (astrocytomas and glioblastomas) with multiple sclerosis (MS). This situation may lead to considerable diagnostic difficulties, yet an accurate appraisal is of prognostic, if not therapeutic, value. There is suggestive but inconclusive evidence that the two conditions may be causally related, malignant astrocytic tumours arising from plaques of MS. The small number of reported cases makes statistical analysis impossible, but the scanty literature may not reflect the true incidence.