Psoas muscle abscess due to Yersinia enterocolitica.

A psoas muscle abscess due to Yersinia enterocolitica developed in a 71-year-old man with mild type II diabetes mellitus. There was no evidence of gastrointestinal infection or septicemia, and treatment with computed tomography-directed percutaneous drainage and cefoxitin resulted in cure. This represents the first known reported case of psoas abscess due to Y. enterocolitica.

The source of biliary infections associated with T-tube drainage.

The purpose of this study was to determine the source of organisms responsible for biliary infection associated with T-tube placement. Two groups of patients who had had T-tubes placed following common bile duct exploration were studied. In one group of 34 patients, bacterial cultures were taken daily from the drainage bag and the lumen of the T-tube. In the second group of patients, paired daily bacterial cultures were taken from the T-tube lumen and the skin tract surrounding the T-tube. Results of the first group showed the drainage bag to be the initial site of infection in seven cases, with "descending" infection from the patient's skin occurring in 27 cases, 14 in whom the organism was initially present in the bile while in the other 13 the organism appeared later. In the second group, of 32 isolates only five were found extraluminally before they appeared within the lumen, these five being all Staphylococcus epidermidis. Thus the majority of bile infections occurring after T-tube placement were found to originate from the patient's own biliary tree or skin.

Serum concentrations of the iodothyronines in elderly subjects: decreased triiodothyronine (T3) and free T3 index.

In four groups of subjects free of thyroid disease, the following determinations were made: serum concentrations of thyroxine (T4), triiodothyronine (T3), reverse T3(rT3) and diiodothyronine (T2), and calculated indices of free thyroxine (FT4) and free triiodothyronine (FT3). Group A comprised healthy subjects aged 16-64; Group B, 24 healthy elderly subjects aged 68-95; Group C, 23 elderly patients with mild well-controlled chronic illnesses, aged 70-85; Group D, 40 nursing home residents aged 66-100. Serum T4 and T2 concentrations and the FT4 index were not affected by age; the rT3 concentration was slightly but significantly elevated only in Group D patients. Serum T3 concentration was significantly lower in all groups of elderly subjects and decreased FT3 index measurements were detected after age 75. It was concluded that old age, without complicating illness, is accompanied only by a decrease in the serum level of T3 and the FT3 index; values for other iodothyronines are unchanged. Clinicians should consider the age-related changes in T3 and FT3 values when interpreting thyroid function tests.

Thyroid function tests in elderly hyperthyroid patients.

Several tests of thyroid function were performed in 35 hyperthyroid patients over the age of 65 (elderly). The results were compared to those of similar tests in 48 hyperthyroid patients under the age of 65 (young). Total serum thyroxine (T4) was within the normal range in 14 percent of the elderly and 11 percent of the young hyperthyroid patients. The free thyroxine index (FTI) was within the normal range in 11 percent of both groups. The triiodothyronine uptake (T3U) proved to be a poor test in both groups. Although elevation of the triiodothyronine (T3) level allowed a diagnosis of "T3-toxicosis" in 2 elderly and 3 young hyperthyroid patients, the T3 level was normal in 34 percent of the elderly and 13 percent of the young subjects. Correction of the T3 range for age reduced the number of normal T3 values to 12.5 percent in the elderly hyperthyroid patients. The 24-hour uptake of radioactive iodine was normal in 12 percent of the young hyperthyroid patients, 27 percent of the elderly patients with Graves' disease, and 70 percent of the elderly patients with toxic nodular goiter, despite recent readjustment of the normal range for the test. It is concluded that the diagnosis of hyperthyroidism in the elderly may be difficult and that no single test can be relied upon to exclude the diagnosis.