Meningococcal disease: treatment and prevention

Many countries have been experiencing a significant increase in meningococcal disease. With the strains currently circulating, septicaemia is now a more frequent manifestation than meningitis and early recognition of disease manifestations by patient, parent or physician as well as early recognition of disease severity are the most important factors in attempting to reduce mortality and morbidity. Ceftriaxone is the treatment of choice but must be accompanied by aggressive supportive therapy in those with severe disease. The role of steroids is unknown. The evidence to support their use in both meningitis and severe systemic sepsis is discussed. The purified polysaccharide vaccines that have been available for some years may play a limited role in disease prevention. The recently introduced conjugate vaccine for preventing serogroup C disease represents a major advance but no vaccine is currently available to prevent serogroup B disease, cases of which will continue to challenge clinical practice.     

Assessment of myocardial viability by nuclear imaging techniques

The assessment of myocardial viability has become important in the diagnostic and prognostic work up of patients with ischemic cardiomyopathy. Patients with viable myocardium may benefit from revascularization in terms of improvement of function, symptoms, and prognosis. In contrast, patients without viable myocardium do not benefit and should be treated conservatively. Various nuclear imaging techniques are available.     

Fatal Hepatic Coma Complicating Oxymetholone Therapy in Multiple Myeloma

Fatal hepatic coma complicating oxymetholone therapy in multiple myeloma. G. P. Young, P. S. Bhathal, J. R. Sullivan, A. J. Wall, D. J. Fone and T. H. Hurley, Aust. N.Z. J. Med, 1977,7, pp. 47–51. Two patients with multiple myeloma died in acute liver failure. Both had been treated with the anabolic steroid oxymetholone and both subsequently developed severe cholestatic hepatitis. In one the histological lesion progressed despite cessation of oxymetholone therapy. Myeloma infiltration of the liver and peliosis hepatis were not seen. As a fatal outcome from cholestatic hepatitis due to oxymetholone is rare it is possible that an unknown potentiating factor is present in multiple myeloma that can lead to a fatal outcome. If oxymetholone therapy is to be used in such patients then close clinical and laboratory assessment of liver function should be carried out in an attempt to prevent this unusual and fatal complication.     

Double outlet right ventricle assessed with Magnetic Resonance Imaging

In this article the value of magnetic resonance (MR) imaging for the evaluation of double outlet right ventricle (DORV) is reviewed from the literature and illustrated with several cases. MR imaging can be used for the determination of cardiac anatomy at initial diagnosis and may provide functional information during the follow-up of patients after surgical correction.     

Perceptions of professional drug treatment staff in England about client barriers to narcotics anonymous attendance

A growing body of research evidence shows that Twelve Step Group (TSG) attendance confers a consistent moderate beneficial effect on substance use. Clinicians potentially represent a major referral pathway to TSG. This qualitative study aimed to explore staff perceptions of the barriers to Narcotics Anonymous (NA) group attendance in a population receiving drug treatment, and potential strategies to increase attendance. A cross-sectional survey of substance misuse treatment professionals was conducted between January and April 2012 in Birmingham, England. Fifty-eight members of staff working within statutory community drug treatment teams were interviewed using qualitative research methods. The overarching themes within the staff accounts are described and the importance of these themes explored. Perceived objections to core elements of the 12 step programme (religious nature of the programme, powerlessness, surrender, desire to stop using drugs) were major obstacles to recommending NA attendance. However, a perception that the client would object to any form of group process, and concerns about risk both to the client and the TSG members were also important. Increased education about TSG practices and procedures was a commonly cited strategy for increasing levels of TSG referral, and in particular ensuring that clinicians attend open meetings themselves. An increased understanding and familiarity with the process and principles of TSGs may be necessary to increase promotion of TSG within drug treatment services in line with recent national policy promoting recovery from drug use.