The tryptophan depletion theory in delirium: not confirmed in elderly hip fracture patients.

Background: The tryptophan depletion theory assumes that low tryptophan levels are present in delirium. These lower levels may be regarded as a biochemical marker for cellular immune activation, which may lead to increased catabolism of tryptophan into kynurenine via stimulation of the enzyme indoleamine 2,3-dioxygenase (IDO) by interferon-γ.

Objective: To compare plasma tryptophan and kynurenine levels, and IDO activity in hospitalized patients with and without delirium.

Cortisol, insulin, and glucose and the risk of delirium in older adults with hip fracture.

Objectives: To determine the relationship between perioperative delirium and cortisol, glucose, and insulin in older adults acutely admitted for hip fracture.

Design: Prospective cohort study.

Setting: Tertiary university center.

The effects of melatonin versus placebo on delirium in hip fracture patients: study protocol of a randomised, placebo-controlled, double blind trial.

Background: With an ageing population, older persons become a larger part of the hospital population. The incidence of delirium is high in this group, and experiencing delirium has major short- and long-term sequelae, which makes prevention crucial. During delirium, a disruption of the sleep-wake cycle is frequently observed.

Cortisol, interleukins and S100B in delirium in the elderly.

In independent studies delirium was associated with higher levels of cortisol, interleukin(IL)s, and S100B. The aim of this study was to simultaneously compare cortisol, IL-6, IL-8, and S100B levels in patients aged 65years and older admitted for hip fracture surgery with and without delirium. Cortisol, IL-6, IL-8, and S100B were assayed in repeated blood samples.

Poor outcomes of chronic active Epstein-Barr virus infection and hemophagocytic lymphohistiocytosis in non-Japanese adult patients.

Chronic active Epstein-Barr virus infection manifests as a combination of persistent infectious mononucleosis-like symptoms and high viral load in apparently immunocompetent patients. It is closely related to Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis. These 2 abnormal Epstein-Barr virus-associated diseases are seldom reported in individuals other than Japanese children and adolescents.

Capnocytophaga canimorsus sepsis presenting as an acute abdomen in an asplenic patient.

Acute abdominal symptoms are frequently caused by surgical intra-abdominal problems. However, the differential diagnosis also includes several internal diseases. Overwhelming infections may present with acute abdominal signs, particularly in the immunocompromised host.

Clinical value of TPS, CEA and CA 15-3 in breast cancer patients.

Serum TPS, CA 15-3 and CEA levels were measured in 121 women with breast cancer. The combination of TPS (which measures tumour activity) and CA 15-3 (which measures tumour mass) had a sensitivity of 72% to detecting metastatic disease (n = 71). All 3 markers could significantly discriminate local versus distant metastatic relapsed breast cancer and TPS was more often elevated in the case of bone metastases.

Translocation (12;22)(p13;q12) as sole karyotypic abnormality in a patient with nonlymphocytic leukemia.

Cytogenetic analysis of unstimulated bone marrow (BM) and peripheral blood (PB) cells of a patient with clinical features of atypical chronic myeloid leukemia (CML) showed t(12;22)(p13;q12) as the sole karyotypic abnormality. Subsequent fluorescence in situ hybridization (FISH) with abl- and bcr-specific cosmids as well as chromosome 12- and 22-specific DNA libraries and Southern blot analysis confirmed that in this patient t(12;22) does not constitute a cryptic Ph variant. Recently, a few very similar cases were reported by other investigations.

Acute pancreatitis due to sulfamethoxazole-trimethoprim.

We have reported a case of sulfonamide-induced acute pancreatitis. A review of the literature showed only eight previously reported cases. Adverse reactions to sulfonamides are well known, but acute pancreatitis is a very serious complication.

Mediastinal hemorrhage after treatment of thyrotoxicosis using radioiodine.

A patient presented with a massive mediastinal hemorrhage due to a ruptured thyroid artery, occurring eight weeks after treatment with radioiodine for thyrotoxicosis. Suspicion of a causal relation is supported by vascular abnormalities found in the thyroid after treatment with radioiodine.

Hypothyroidism leads to more small-sized platelets in circulation.

The effect of induced hypothyroidism on platelet count and platelet volume distribution was studied in twelve athyreotic patients. After a two weeks withdrawal of triiodothyronine supplementation, platelet count and the ratio between platelet and red cell count were increased in all patients. Furthermore, mean platelet volume was declined and platelet distribution width was risen.

Van Buchem's disease and aneurysmal bone cyst. A case history.

A patient suffering from Van Buchem's disease combined with an aneurysmal bone cyst in the para-acetabular region is described. The extreme rarity of both the primary disease and its combination with an aneurysmal bone cyst is discussed with respect to the clinical, radiological, and laboratory features.