Cerebral infarction associated with heparin-induced thrombocytopenia in a patient with encephalitis.

We report a patient who had cerebral infarction associated with heparin-induced thrombocytopenia (HIT) during treatment of aseptic encephalitis. In patients with intracranial inflammation, such as ours, the possibility of HIT has to be considered when heparin is used, since inflammatory cerebral lesions often cause vascular damage, which is an aggravating factor for HIT-associated thrombosis.

Carotid atherosclerosis is associated with brain atrophy in Japanese elders.

BACKGROUND: The relation between atherosclerosis and brain atrophy remains unclear in patients with risk factors for cardiovascular diseases. OBJECTIVE: This study was performed to clarify the relation between brain atrophy and carotid atherosclerosis. METHODS: A total of 142 patients (78 women and 64 men, mean age 74 years) with no neurologic disturbances were studied. Brain atrophy was evaluated on the basis of the brain atrophy index (BAI, BAI = brain parenchyma/intracranial space A 100%), calculated by means of digitized computed tomographic scans obtained at the level of the basal ganglia. Carotid atherosclerosis was evaluated on the basis of the plaque score (PS), defined as the sum of all plaque heights in both carotid arteries, intima-media thickness (IMT), and vessel diameter (VD) of the common carotid artery as assessed by ultrasonography. RESULTS: Age negatively correlated with BAI in both men (r = -0.587, p < 0.001) and women (r = -0.724, p < 0.001). PS of the carotid artery also negatively correlated with BAI in men (r = -0.502, p < 0.001) as well as women (r = -0.480, p < 0.001). VD and IMT of the right carotid artery negatively correlated with BAI in women (VD; -0.256, p < 0.05, IMT; -0.216, p < 0.05) but not in men. Other characteristics were unrelated to BAI. Multiple regression analysis showed that age and PS were independent predictors of brain atrophy in both sexes. The percentage of variance of BAI values explained by this model in women (51.9%) was much greater than that in men (35.5%). CONCLUSION: Carotid atherosclerosis may be a useful morphological index of brain atrophy.

[Analysis of factors affecting prolonged hospitalizations in elderly patients with community-acquired pneumonia].

To determine the factors involved in prolonged hospital stay of elderly patients (over 60 years old) with community-acquired pneumonia (CAP), we investigated: (1) the age, (2) underlying diseases, (3) severity of pneumonia, and (4) length of hospital stay etc. of such cases at a 19-bed local facility. Of the 30 elderly patients with CAP, 20 had no underlying diseases (Group A). The mean length of hospital stay for these patients was about 10 days (mean age 69.1 years). The other 10 patients examined had some chronic underlying diseases, and these patients were assigned to Group B. The mean length of hospital stay in this group was 17 days (mean age was 71.2 years). The finding that the mean length of hospital stay was significantly shorter in Group A than in Group B indicates that prolonged stay of elderly patients with CAP is associated with the presence of underlying chronic diseases. When the severity of pneumonia of patients with underlying chronic diseases increased by one level according to the Guidelines of the Japanese Respiratory Society (2000), the number of patients with moderate pneumonia was 13, and the mean length of hospital stay was 16 days. The number of patients with mild pneumonia was 17, and the mean length of hospital stay was 10 days. Thus, the length of hospitalization was significantly shorter in the mild group than in the moderate group.