Successful treatment of Lyme encephalopathy with intravenous ceftriaxone.

The efficacy of intravenous ceftriaxone, 2 g per day for 30 days, was evaluated in a case series of 18 consecutive patients who met strict criteria for Lyme encephalopathy. Months to years after classic manifestations of Lyme disease, the 18 patients presented with memory difficulty, minor depression, somnolence, or headache. Sixteen (89%) had abnormal memory scores; 16 (89%) had cerebrospinal fluid (CSF) abnormalities, and all 7 patients tested had frontotemporal perfusion defects on single photon emission computed tomographic (SPECT) imaging. Six months after treatment, memory scores in the 15 patients who completed the study according to protocol were significantly improved (P<.01). In the 10 patients who had follow-up CSF analyses, total protein levels were significantly lower (P<.05). In the 7 patients who had SPECT imaging, posttreatment perfusion was significantly better (P<.01). Twelve to 24 months after treatment, all 18 patients rated themselves as back to normal or improved. We conclude that Lyme encephalopathy can be treated successfully with ceftriaxone.     

Self-report symptoms that predict major depression in patients with prominent physical symptoms

The diagnosis of depression in patients presenting with both depressive and physical symptoms is potentially confounded and problematic. The present study of 271 patients with four types of illness all with prominent physical symptoms--end-stage renal disease (n = 99), irritable bowel syndrome (n = 21), post-infectious neuromyasthenia (n = 25) and eating disorders (n = 126)--investigates if there are a group of symptoms on the Beck Depression Inventory (BDI) which predict the diagnosis of major depressive episode (MDE) made using the Diagnostic Interview Schedule (DIS). Discriminant function analysis of BDI responses yielded a four item function--self-hate, indecisiveness, loss of appetite and suicidal thoughts--which maximally discriminated between patients with and without a current MDE and correctly classified 75 percent of subjects.     

Heparin skin necrosis: delayed occurrence in a patient on hemodialysis

A case of skin necrosis in a patient receiving intravenous (IV) heparin during routine intermittent hemodialysis is reported. Multiple erythematous, tender lesions developed over the abdomen and thighs and rapidly became necrotic. Biopsies showed fibrin thrombi in the dermal venules and capillaries, but no cellular infiltrate. The patient was in her third month of regular hemodialysis. Skin necrosis associated with the use of heparin usually occurs within 2 weeks of beginning heparin therapy and has not been reported in patients receiving heparin with hemodialysis. Possible mechanisms, including acquired antithrombin III deficiency leading to heparin-induced skin necrosis, are discussed.     

Occupational therapy for children with perinatal HIV infection

This article discusses occupational therapy for children with perinatal HIV infection and their care-givers. An interdisciplinary early intervention and preschool program serving these children is described. Current medical and neurological research is reviewed to serve as a basis for occupational therapy intervention. Therapeutic approaches that integrate physical, neurological, developmental, and psychosocial needs are presented.     

Long-Term Administration of Controlled-Release Oxycodone Tablets for the Treatment of Cancer Pain

We conducted a study of the safety of controlled-release (CR) oxycodone tablets (OxyContin® Tablets) administered chronically to patients with cancer-related pain in a usual clinical setting. These patients had participated in 1 of 2 double-blind, active-control studies. Our study was an open, 3-month treatment study that included 87 patients. Patients received CR oxycodone tablets every 12 hr in a manner that reflected typical clinical practice. Supplemental immediate-release (IR) oxycodone was available PRN for breakthrough pain. Patients recorded medication use, adverse events, and evaluations of pain intensity and acceptability of therapy in a daily diary. Forty-four patients (51%) completed all 12 weeks of study; 43 patients (49%) discontinued participation. At baseline and throughout the study period, the overall mean pain-intensity score was slight to moderate. A comparison of initial and final doses showed a significant but modest increase in total daily CR oxycodone dose. An increase or decrease in titration of the oxycodone dose occurred for 66 patients (84%) at least once during the 12-week study period, primarily for increased pain. Forty-four patients (56%) did not undergo dose titration when the latter was indicated. Hay of the patients used IR oxycodone rescue almost daily; the mean number of rescue doses per day was 1.5. Despite stable pain control and an increasing total daily CR oxycodone dose, the percentage of patients reporting common opioid-related adverse events decreased over the course of the study. CR oxycodone tablets administered every 12 hr were successfully used to manage cancer pain over a 12-week period. Importantly, side effects diminished over time without a concomitant change in efficacy.     

Pulmonary infection following exodontia in a patient with glycoprotein-180 deficiency

There is a significant increase in the occurrence and severity of infection in patients with immunodeficiencies, especially after minor invasive procedures. Therefore, alternatives to invasive procedures, continual vigilance of indwelling catheters, and appropriate preoperative evaluation and management of these patients are of paramount importance.     

Invited review: peripheral neuropathy in Sjogren's syndrome

Our experience and review of the literature reveal that Sjogren's syndrome (SS) is an important, poorly recognized cause of peripheral neuropathy. Several forms of peripheral nerve dysfunction occur in SS including trigeminal sensory neuropathy, mononeuropathy multiplex, distal sensory neuropathy, distal sensorimotor peripheral neuropathy and a pure sensory neuronopathy syndrome. Rarely, chronic relapsing inflammatory polyneuropathy and multiple cranial neuropathies appear. Clinical evidence of glandular involvement is often minimal or absent when patients with SS develop peripheral neuropathy; and the diagnosis of the underlying condition is elusive. We review clinical and laboratory features of this disorder and suggest appropriate evaluation of patients with neuropathy and suspected SS.     

Immunophenotypic analysis with enhanced sensitivity of detection by enzymatic amplification staining.

Single cell analysis by flow cytometry is a powerful diagnostic modality that has been limited by poor resolving power. Molecules expressed on the cell surface in abundance (i.e., greater than 1000 molecules per cell) can be detected readily by conventional staining technologies; however, molecules expressed in lower concentrations cannot be easily observed. Because there are many molecules that are functionally significant at lower levels of expression, the capability to detect these molecules is important. Enzymatic amplification staining is a new flow cytometric amplification technology based on the enzymatically catalyzed deposition of reporter molecules. This technology allows for the detection of molecules expressed on the cell surface at low abundance. The authors have demonstrated that EAS can be used to resolve the expression of molecules that cannot be resolved with standard amplification procedures. It has been shown that this capability is valuable in the diagnostic evaluation of patient samples; moreover, it is likely that EAS can be profitably used in the analysis of both malignant and reactive blood cells from various patients.