DEPRESSION IN DEMENTIA: A STUDY OF MOOD IN A COMMUNITY SAMPLE AND REFERRALS TO A COMMUNITY SERVICE

The association between degree of cognitive impairment and severity of depressive symptoms was examined in a randomly selected community-based sample of elderly people and in a sample of patients referred to an old age psychiatry service. Findings contradict previous reports of less cognitive impairment in demented patients with depressive symptoms. We suggest that sample selection bias has contributed to the earlier reports. © 1997 John Wiley & Sons, Ltd.     

A Rare Case of Non-small Cell Lung Carcinoma Squamous Phenotype with Epstein-Barr Virus Positivity with Prolonged Response to both Chemotherapy and Radiotherapy

We present a rare challenging case of metastatic non-small cell lung cancer with Epstein-Barr virus positivity that was also diagnosed with pulmonary tuberculosis at the same time. Palliative chemotherapy gemcitabine and carboplatin was started after two weeks of anti-tuberculosis treatment with the hopes that this period would be sufficient to keep acid fast bacilli non-viable to minimise risk of tuberculosis re-activation due to chemotherapy induced immunosuppression. She completed four cycles of chemotherapy and six months of anti-tuberculosis treatment with good results and minimal side effects. Two years later, there was disease recurrence in cervical and mediastinal lymph nodes which was treated with local treatment i.e. surgery and palliative radiotherapy. It has been two years since last radiotherapy and overall more than five years since diagnosis with no active disease at present. Given the complexity and rarity of this case, significant multidisciplinary team involvement, including oncologists and radiation oncologists, pulmonologists with special interest in tuberculosis and pathologists was necessary throughout.     

FAMILIAL HYPOCALCIURIC HYPERCALCAEMIA: ASSOCIATION WITH NEONATAL PRIMARY HYPERPARATHYROIDISM, AND POSSIBLE LINKAGE WITH HLA HAPLOTYPE

A kindred is described, six members of which fulfilled criteria for the syndrome of familial hypocalciuric hypercalcaemia (FHH). The majority of these individuals were asymptomatic: their hypercalcaemia was revealed by biochemical screening after parathyroid surgery had failed to diminish the elevated serum calcium concentration of the index case. In contrast to those members of the family diagnosed as adults, the daughter subsequently born to the index case included in her expression of FHH clinical features of severe neonatal primary hyperparathyroidism. Four hyperplastic parathyroid glands were excised, and following surgical intervention the baby improved clinically and accelerated the healing of her skeletal lesions. Her case suggests that an association does exist between FHH and neonatal primary hyperparathyroidism. Of the ten individuals at risk, inheritance of hypocalciuric hypercalcaemia was paralleled in eight cases by inheritance of the HLA haplotype All BW55 CW3 DR4. Such possible linkage has not previously been reported.     

A TEST OF TWO TYPES OF HALOTHANE VAPORIZER

Two different types of halothane vaporizer are compared. TheGoldman is simple, small and inefficient as a vaporizer. TheFluotec is relatively large, complicated, and highly efficient.It is suggested that there is a need for a modified versionof the simple type, capable of producing up to 5 per cent vapour.It is further suggested that it is not necessary, in clinicalpractice, to be able to vary the concentrations by very accuratelyknown small amounts. To be able to do so is an expensive andunnecessary luxury which is not attainable in practice and theoreticallycarries the risk of accidentally delivering a gross overdose.     

CEREBRAL ABSCESS: MANIFESTATION OF PULMONARY ARTERIOVENOUS MALFORMATIONS

Two cases in which cerebral abscess was the initial presenting feature of pulmonary arteriovenous malformations are reported. Cerebral abscess recurred in one patient. The pulmonary malformations were multiple and bilateral in both cases. One patient had associated features of hereditary hemorrhagic telangiectasia. Surgical resection of the largest malformations was performed in both cases. Cerebral abscess did not recur in either case post-operatively, though this may not have been due to surgical intervention.