Osteoporosis--a diagnostic problem in geriatric consultation

On the basis of x-ray morphometric examinations employing 2,500 x-ray photographs age- and sex-specific standard value curves of the bone mineral content are ascertained for the methods by Singh, Saville and Barnett/Nordin. Evaluations leads to the refusal of the wide clinical application of these methods. The combined application of these methods with microradioscopy employed in the forefield diagnostics of demineralizing skeleton diseases is possible only with proviso.     

Inositol 6 g daily may be effective in depression but not in schizophrenia

Inositol is an important precursor for second messenger synthesis and has been reported to be reduced by lithium treatment in rat brain and in human CSF in depression. An open trial of 6 g/day in 11 depressed patients resistant to previous treatment led to major improvement in nine patients. The enzyme synthesizing inositol has been reported to be elevated in schizophrenia, suggesting an attempted compensation for possible inositol deficiency. A controlled double-blind crossover trial in 10 chronic schizophrenic patients of 6 g/day of inositol for 30 days did not reveal any benefit.     

Outbreak of carbapenem-resistant Acinetobacter baumannii producing the OXA-23 enzyme in Curitiba,Brazil

Carbapenem-resistant Acinetobacter baumannii isolates were obtained from eight patients in two hospitals in Curitiba, Brazil. The isolates were multiresistant, belonged to a single strain, and produced the OXA-23 carbapenemase. Treatment options were limited, although the isolates were susceptible to polymyxin B in vitro. The strain contributed to the deaths of five patients.     

Electroconvulsive therapy in adolescent and adult psychiatric inpatients--a retrospective chart design

BACKGROUND: The knowledge available on electroconvulsive therapy (ECT) in adolescents is largely anecdotal, or based on findings from adults. The aim of the present study is to compare the use of ECT in adolescent and adult inpatients. METHODS: We retrospectively analyzed the files of all 36 adolescent (between the ages of 13 and 19) and 57 randomly selected adult inpatients (above the age of 20) treated with ECT in a university-affiliated mental heath center in Israel between 1991 and 1997. RESULTS: Sixty one percent of the adolescents improved by the end of treatment, and 53% were not hospitalized in the subsequent year. The respective percentages among adults were 83% and 49%. Whereas most adults were treated with ECT because of schizophrenic disorders, almost half of the adolescents received ECT for affective disorders. Significantly more adolescents were treated with ECT because of acute life-endangering conditions (catatonia or severe suicidal risk). No significant adverse effects were found in both groups. LIMITATIONS: Our study is based on a retrospective chart review. The adolescent and adult groups are different in psychiatric morbidity, diagnosis and outcome, have not been assessed in a blind manner, and we have not used standardized psychometric batteries for the evaluation of ECT-related memory disturbances. CONCLUSIONS: ECT may be an effective, well-tolerated and safe procedure in both adult and adolescent inpatients.     

Surgical repair of retinal detachment secondary to cytomegalovirus retinitis

BACKGROUND AND OBJECTIVE: This study was conducted to determine preoperative predictors of postoperative visual acuity in patients with acquired immunodeficiency syndrome (AIDS) and cytomegalovirus (CMV) retinitis and retinal detachment. PATIENTS AND METHODS: The study design was a retrospective chart review of 38 eyes in 33 patients with AIDS and CMV retinitis who had retinal reattachment surgery by pars plana vitrectomy with the use of silicone oil tamponade. Factors considered included: preoperative visual acuity, macular attachment status and CMV activity at the time of surgery, and length of time from diagnosis of retinal detachment to surgical repair. RESULTS: Retinal reattachment was achieved in 37 of 38 eyes. Mean interval from surgery to best corrected visual acuity (VA) was 9 weeks. The mean best corrected post-op VA was 20/70. Approximately half of the patients died within 7 months of the surgery. There was good correlation between preoperative VA and best attained postoperative VA (Spearman's: r = 0.5139, P = 0.001). The interval from retinal detachment to surgery, and best attained postoperative VA did not correlate (Spearman's: r = 0.2339, P=0.158). The lack of macular CMV retinitis correlated well with postoperative VA (P = 0.0066, Wilcoxon rank-sum test). CONCLUSIONS: Preoperative visual acuity and macular attachment status correlates with better postoperative visual acuity results, whereas early surgical repair of retinal detachment does not.     

Fatal meningoencephalitis due to Bacillus anthracis

Abstract: We report the first case of fatal anthrax meningoencephalitis in Hong Kong over the past 60 years. A 13 year-old boy presented with right lower quadrant pain, diarrhoea and progressive headache. Lumbar puncture yielded gram positive bacilli initially thought to be Bacillus cereus, a contaminant. He was treated with ampicillin and cefotaxime, but died 3 days after hospitalization. The organism isolated from blood and cerebrospinal fluid was later identified as Bacillus anthracis.