The time of day that etidronate is ingested does not influence its therapeutic effect in osteoporosis

To investigate whether the therapeutic effect of etidronate is affected by the time of ingestion we have retrospectively studied 110 osteoporotic patients. They had been taking etidronate according to the manufacturer's instructions for a mean duration of 2.6 years either on waking (n=47), on retiring (n=47), or during the day (n= 16). No significant differences were found between the three groups with respect to percentage change in bone mineral density at all sites either for the first year of treatment or for the mean yearly percent change throughout the total course of treatment. These findings suggest that the time of ingestion of etidronate does not influence the therapeutic effect if a two hour fast before and after ingestion is adhered to.     

Pituitary ACTH dependency of nodular adrenal hyperplasia in Cushing's syndrome: Report of two cases and review of the literature

Cushing's syndrome due to nodular adrenal hyperplasia comprises a clinically and biochemically heterogeneous group of disorders whose pathogenesis is unclear. We describe two patients with atypical steroid dynamics and large unilateral adrenal nodules who had pituitary ACTH-dependent disease. In the differential diagnosis of Cushing's syndrome, we recommend repeated ACTH measurement and selective venous sampling—particularly in those patients with impaired dexamethasone suppressibility and abnormal findings on computerized tomography.     

Salmonella typhi infections in the United States, 1975-1984: increasing role of foreign travel

To explore changes in the epidemiology of typhoid fever in the United States, cases reported to the Morbidity and Mortality Weekly Report (MMWR) and typhoid case report forms submitted by state and local governments are reviewed. The incidence of typhoid fever in the United States fell from one case per 100,000 population in 1955 to 0.2 cases per 100,000 in 1966 and has since remained fairly stable. Review of case report forms for 2,666 cases of acute typhoid fever that occurred between 1975 and 1984 showed that 62% were imported, in contrast to only 33% during 1967-1972. The proportion of cases imported has continued to rise, reaching 69% in 1984. The major sources of the 1975-1984 cases were Mexico (39%) and India (14%). The case-fatality rate was 1.3%. Antimicrobial resistance was a minor problem, and large outbreaks were unusual. Further decline in the incidence of typhoid fever in the United States probably must await the advent of an effective vaccine with minimal adverse effects for use by travelers.