Polyneuropathie als Leitsymptom eines γ-G-Plasmocytoms

Summary A 79-year-old female patient was hospitalized because of polyneuritis and polyradiculitis. In this case it could be made likely that polyneuritis and polyradiculitis were due to the paraproteinemia accompanying the plasmacytoma, a relationship only rarely described to date.     

Clinical presentation and surgical management of dissecting posterior inferior cerebellar artery aneurysms: 2 case reports

Intracranial dissection presenting with subarachnoid hemorrhage (SAH) most commonly involves the vertebral artery. The natural history of this lesion suggests frequent early rehemorrhage and need for urgent treatment. Isolated dissection of the posterior inferior cerebellar artery (PICA) is very rare. We present 2 cases of isolated PICA dissections presenting with SAH. Both patients were middle-aged men who presented with transient loss of consciousness, severe headache, and cranial neuropathies. Initial angiography showed dilatation and narrowing of PICA consistent with dissection and aneurysm formation. The vertebral arteries were normal and there was no other cause for the SAH. Repeat angiography 2 weeks after admission revealed significant enlargement of the aneurysmal dilation of the dissected segment of PICA in both patients. Both patients were treated operatively. One patient had clip reconstruction of the PICA with preservation of flow through the PICA. Follow-up angiography one year later showed no recurrence. The other patient underwent direct surgical trapping and resection of the dissected segment of PICA after passing balloon occlusion testing at the vertebral-PICA junction. Both patients have more than 2 years of clinical follow-up and remain well. Isolated PICA dissection seems to have a less ominous natural history compared to vertebral artery dissection. These lesions need to be followed carefully for evidence of aneurysmal enlargement. Direct surgical reconstruction of the dissected segment may be possible. Balloon occlusion testing may be very helpful in determining if the involved PICA segment can be sacrificed.     

Minimum inhibitory and bactericidal concentrations of 44 antimicrobial agents against three standard control strains in broth with and without human serum.

Standard minimum inhibitory and bactericidal concentrations are not established for most antimicrobial agents against strains of bacteria commonly used for quality control in susceptibility testing. The effects of cation and human serum supplementation of broth on the values are also unknown. Therefore, we performed 10 minimum inhibitory and bactericidal concentration determinations for 44 antimicrobial agents against the standard control strains Escherichia coli ATCC 25922, Staphylococcus aureus ATCC 25923, and Pseudomonas aeruginosa ATCC 27853 in Mueller-Hinton broth and in Mueller-Hinton broth supplemented with calcium, magnesium, and 50% pooled human serum. Agreement of replicates was within one twofold dilution 97% of the time. Supplemented Mueller-Hinton broth gave higher minimum inhibitory concentrations for 24 antibiotics against S. aureus, for 17 drugs against E. coli, and for 12 drugs against P. aeruginosa, whereas it gave lower minimum inhibitory concentrations for 1 antibiotic against S. aureus, for 5 against E. coli, and for 5 against P. aeruginosa. Results for minimum bactericidal concentrations were similar. Added serum did not further affect the increased resistance of P. Aeruginosa to aminoglycosides encountered with cation supplementation of broth. These results provide expected values for the quality control strains when minimum inhibitory and bactericidal concentrations are determined in these two Mueller-Hinton media.     

Treatment of functional chronic stooped posture using a training device and behavior therapy. A case report

Functional posture problems and related gait problems are often difficult to manage clinically because of the difficulty of providing immediate feedback to clients during walking or standing and because of secondary personal gains provided the client for having the "disability." This article describes an inexpensive posture training device and treatment of a client with developmental disabilities and a long history of posture problems and secondary gait pattern abnormalities. Thirty-six short training sessions, coupled with a supportive daily living situation, produced marked improvements in the client's posture and gait.     

New psychiatric and psychological aspects of diagnosis and treatment of hepatitis C and relevance for opiate dependence

PURPOSE OF REVIEW: This review highlights the aspects of the hepatitis C virus that are important to the psychiatrist. RECENT FINDINGS: Hepatitis C virus infection is frequently associated with mental clouding, depression, neurocognitive impairment, and deterioration in the quality of life. In recent studies psychiatric symptoms have been linked to psychiatric comorbidity rather than to direct hepatitis C virus neurotoxicity. Infection of the central nervous system, however, is thought to play a role at least in hepatitis C virus associated neurocognitive deficits. Application of the anti-hepatitis C virus agent interferon-alpha is regularly accompanied by psychiatric symptoms, most often depression. Antidepressant treatment may support interferon therapy, but its general indication and timing remain debatable. The problem of hepatitis C virus treatment in manic patients is still unsolved. Hepatitis C infection rates in injection drug users are often 90% and higher, while these patients in particular face barriers when trying to access treatment. Recent studies demonstrated feasibility of hepatitis C virus treatment in injection drug users in specialized treatment settings. SUMMARY: Hepatitis C virus infection is associated with psychiatric comorbidity and injection drug use, while treatment of the virus is frequently accompanied by neuropsychiatric symptoms. Psychiatrists are particularly qualified to support diagnosis of hepatitis C associated comorbidity and to render treatment feasible. Evaluation of treatment options and settings in infected patients with psychiatric comorbidity or injection drug users is required, as well as investigation of association of hepatitis C virus infection, and psychiatric and neurocognitive symptoms in properly defined samples.     

Dietary restriction does not adversely affect bone geometry and mechanics in rapidly growing male wistar rats

The present study assessed the effects of dietary restriction on tibial and vertebral mechanical and geometrical properties in 2-mo-old male Wistar rats. Two-month-old male Wistar rats were randomized to the ad libitum (n=8) or the 35% diet-restricted (DR) feeding group (n=9) for 5 mo. Tibiae and L6 vertebrae were dissected out for microcomputed tomography (microCT) scanning and subsequently fractured in biomechanical testing to determine geometrical and mechanical properties. The DR group had significantly lower mean tibial length, mass, area, and cross-sectional moment of inertia, as well as vertebral energy to maximal load. After adjustment for body mass, however, DR tibial mean maximal load and stiffness, and DR vertebral area, height, volume, and maximal load were significantly greater, relative to ad libitum means. No significant differences were found between the DR and ad libitum mineral ash fractions. Because the material properties of the tibiae between the two groups were not significantly different, presumably the material integrity of the bones was not adversely affected as a consequence of DR. The similar material characteristics were consistent with mineral ash fractions that were not different between the two groups. Vertebral maximal load and stiffness were not significant between the DR and ad libitum animals. Importantly, we show that a level of dietary restriction (35%) that is less severe than many studies (40%), and without micronutrient compensation does not adversely affect tibial and vertebral mechanical properties in young growing male rats when normalized for body mass.