Lithium Therapy in Old Age: Recommendations from a Delphi Survey.

INTRODUCTION: While lithium (Li) has been well established for the treatment of bipolar disorder, geriatric patients require special attention when it comes to issues of drug safety. Declining renal function, amongst other medical conditions, and polypharmacy may pose increased risks. Only a few previous studies have addressed the management of Li in geriatric patients. METHODS: Twenty-four German medical experts on geriatric medicine and Li treatment participated in a Delphi survey, consisting of two rounds of questionnaires and a final formulation of treatment recommendations. Three major issues of Li therapy were outlined: initiation of treatment, monitoring of ongoing therapy, and withdrawal due to medical reasons. Final recommendations were consented to at a threshold of at least 80% expert agreement. RESULTS: Final consensus was achieved on 21 clinical recommendations. The approved recommendations covered aspects of necessary laboratory checks, concomitant medication, and target Li serum concentration in geriatric patients. Concerning the termination of Li therapy, an agreement was reached on the appropriate time span for tapering and on potential alternatives to Li. No consensus was achieved on whether concomitant dementia or frailty should be considered contraindications for Li treatment and the appropriate threshold of the estimated glomerular function rate for withdrawing Li. CONCLUSION: According to the view of German experts, Li may be used in geriatric patients, but it should be monitored carefully. However, the lack of consent in several specific treatment situations underlines the need for research on specific issues of Li therapy.

Management of Open Abdominal Wounds With Intestinal Fistula Formation Using a Combination of Negative Pressure Wound Therapy With Instillation and Dwell Time and New Generation Fistula Devices: A Case Report.

INTRODUCTION: Open abdominal wounds with intestinal fistula formation are challenging complications in abdominal surgery. Special fistula devices (SFD) used along with negative pressure wound therapy with instillation and dwell time (NPWTi-d), may improve management of these wounds, increasing NPWT dressing durability and helping decrease dressing leakage. CASE REPORT: A 57-year-old, obese (body mass index: 55 kg/m²) female with a long history of Crohn disease and multiple intestinal resections, presented with an incarcerated parastomal hernia, abscess formation, and septic shock. After the hernia was repositioned and the infection controlled, a bovine mesh-augmented hernia repair was performed. Skin rotation flaps for wound closure became necrotic and led to an infected, open abdominal wound measuring about 60 cm x 50 cm with formation of 2 additional small bowel fistulas alongside the ostomy and a massive bacterial and fungal superinfection. After surgical debridement, NPWTi-d with 10 minutes soaking time with isotonic saline solution followed by 2 to 4 hours negative pressure therapy with -125 mm Hg combined with SFDs was initiated; once the infection was controlled approximately 3 weeks after initiation, treatment was switched to traditional NPWT with -125 mm Hg continuous negative pressure and SFDs. Dressings were changed on demand. During the whole treatment period, local infection was brought under control, the wound was clean, and thick granulation tissue formed (even on exposed parts of the mesh). The dressing stability provided a high level of patient comfort. CONCLUSIONS: By providing expedient wound cleaning, decontamination, local infection control, and patient comfort, as well as helping generate granulation tissue even on biological mesh, NPWTi-d used with SFDs represents a viable tool for the management of challenging fistulizing abdominal wounds.

[Death by illegal drugs in Bavaria 1990 up to 2002]. / Drogentote in Bayern 1990 bis einschliesslich 2002.

OBJECTIVE AND METHOD: In our paper we report about drug mortality in Bavaria in the years 1990 up to 2002, using statistical trend tests (Spearman rho, Kendall tau). RESULTS: We observed an increase of deaths by illegal drugs in Bavaria as whole, on the other hand also decreases in different parts of the country.

[Differentialdiagnostic problems of frontotemporal dementia--a case study]. / Differenzialdiagnostische Uberlegungen zur frontotemporalen Demenz anhand einer Kasuistik.

A case study on the clinical picture of frontotemporal dementia and the differential diagnostic problems will be described.

[Diagnostic Problemes Morbus Pick versus Depression] / Differenzialdiagnostische Schwierigkeiten Morbus Pick versus Depression - Eine Kasuistik.

A case study based on the clinical picture and the short term course we describe diagnostic problems in a case of Morbus Pick.

[Suicides and Suicid Rates in Germany, Bavaria and Upper Frankonia] / Suizidzahlen und -raten im Vergleich Deutschland, Bayern und Oberfranken.

The authors give an actual survey about suicides and suicide rates in Germany, Bavaria and Upper Frankonia. Their special interest are significant trends in the last years. These trends will be shown and shortly described.

[Differential diagnostic difficulties in Pick disease versus depression--a case report]. / Differenzialdiagnostische Schwierigkeiten Morbus Pick versus Depression--Eine Kasuistik.

A case study based on the clinical picture and the short term course we describe diagnostic problems in a case of Morbus Pick.

[Suicide date and rates in a comparison of Germany, Bavaria and Upper Frankonia]. / Suizidzahlen und -raten im Vergleich Deutschland, Bayern und Oberfranken.

The authors give an actual survey about suicides and suicide rates in Germany, Bavaria and Upper Frankonia. Their special interest are significant trends in the last years. These trends will be shown and shortly described.

[Death by illegal drugs in Bavaria-data from 1990 up to 2000]. / Drogentote in Bayern - Entwicklung von 1990 bis einschliesslich 2000.

Abstract. Mortality has often been regarded as a measure for overall outcome and both treatment and drug policy effectiveness. The number of deaths by illegal drugs from the years 1990 - 2000 in Bavaria were analysed using statistical trend tests (Spearman rho and Kendall tau). In Bavaria in general (p = 0.014) as well as in 5 out of seven counties a significant increase in drug related mortality was found.