Estimates of the prevalence of bipolar affective disorder METHODS BASED ON TREATMENT WITH LITHIUM

During this century the epidemiology of the affective disorders has been studied, several classifications have been described and effective treatment measures have been introduced. Difficulties have been encountered in the epidemiology area due to inconsistent use of the terminology of measurement and varying types of classification; although it is possible to arrive at a broad consensus of agreement if the data are examined restrictedly. The clinical need for accurate rates of illness has become greater since the inception of the prophylactic drug lithium carbonate. While not used specifically for bipolar affective disorder, it is only for this disorder that its use has been demonstrated beyond doubt. The occurrence of mania in this disorder enables this aspect of the condition to be used as a marker. This paper describes three measures of the period prevalence of bipolar affective disorder, based upon treatment with lithium, two of which are of the ‘unobtrusive’ type. Agreement was found between the three approaches and the utility of these for general use is discussed.     

The pharmacokinetics of an oral form of carbenicillin in patients with renal failure

An orally active ester of carbenicillin was administered to patients with varying degrees of renal dysfunction. The peak serum levels and serum half-life were found to be increased in patients with renal failure. Urine levels, however, in these patients were above the minimum inhibitory concentration for the majority of urinary tract pathogens.     

Motor points for neuromuscular blockade of the adductor muscle group

We sought to identify the motor nerve points for the adductor muscle group, relate them to specific surface anatomy markings, and define the points in terms of percentage distances along an anatomic reference line. We dissected four muscles in each of 20 legs from 15 skeletally mature, formalin-preserved cadavers. Multiple motor branches occurred in 21 of the 80 muscles dissected, but in only four limbs were they observed for more than one muscle in the group. Motor points (defined as the entry point of the motor branch into the muscle) were identified for each muscle along a reference line from the symphysis pubis to the medial joint line at the distal extent of the medial femoral condyle. The mean motor points and 95% confidence limits were as follows: adductor longus, 31% +/- 1.1%; adductor brevis, 22% +/- 1.8%; adductor magnus, 38% +/- 2.5%; and gracilis, 44% +/- 3.1%. Identification of these motor points facilitates accurate placement of neuromuscular blocking agents, such as botulinum toxin, and may lead to increased clinical efficacy of the block with a reduction in local or systemic side effects.     

Cognitive evaluation following NMR imaging of the brain.

Nuclear magnetic resonance imaging of the brain will soon be a standard neuroradiological investigation. Previous work has indicated that this is a safe procedure. Tests which measure various aspects of cognition were performed on volunteer subjects before and after (medium and short term) NMR brain imaging and indicate that deterioration did not occur.     

Sacral tuberculosis: a case report and review of the literature

BACKGROUND: We present a patient with a heterogeneously enhancing lesion within the body of the sacrum and the sacral canal. Sacral tuberculosis (TB) was suspected because of a history of familial exposure. Few cases isolated to the sacrum have been reported in the literature. The characteristic histopathologic and magnetic resonance imaging (MRI) findings are also presented. CASE DESCRIPTION: A 31-year-old African-American male presented with an 8-month history of lower back pain radiating into his legs as well as numbness and weakness of the right foot. His history revealed PPD conversion following an exposure to active pulmonary TB 3 years prior for which he received 6 months of isoniazid prophylaxis. An MRI scan revealed a large heterogeneously enhancing lesion involving the sacrum with extension into the sacral canal. The patient underwent computed tomography (CT)- guided needle biopsy of the sacral lesion. Cytopathologic examination revealed caseating granulomas. Acid-fast bacilli cultures were positive for Mycobacterium tuberculosis. He was placed on a 6-month course of isoniazid, rifampin, pyrazinamide, and ethambutol. At 3-month follow-up, his examination and symptoms had improved. CONCLUSIONS: Sacral TB is an extremely rare cause of lower back pain with radiation into the lower extremities. TB should always be considered in the differential diagnosis of isolated sacral masses, especially in light of today's increasing multidrug resistance and immunosuppressed population.