[Psychosomatic rehabilitation: effects of pre-treatment counselling under the statutory pension insurance scheme]. / Psychosomatische Rehabilitation: Effekte einer prästationären Beratung durch die Rentenversicherung.

BACKGROUND: Currently, little is known about the influence of pre-treatment in rehabilitation outcomes of patients with psychosomatic symptoms. This study examines whether there are differences in therapy motivation and impairment between patients with and those without pre-treatment measures. Additionally, the outcome for patients with prior knowledge of psychosomatic rehabilitation is analyzed. METHODS: As part of a randomized controlled pre-post design the Patients' questionnaire of therapy motivation (PAREMO) and the Brief Symptom Inventory (BSI) were distributed to 166 patients in psychosomatic rehabilitation. The selection of patients with prior knowledge of psychosomatic rehabilitation was made according to the scale "knowledge" of the patients' questionnaire. Changes were tested by analysis of variance at two treatment points. RESULTS: Although there were positive effects of rehabilitation, no interaction was found between measurement points and groups. The analyses of patients without prior knowledge of psychosomatic rehabilitation showed different outcomes for males and females. Higher rehabilitation outcomes for females than for males were found on the BSI scales "somatisation", "phobic anxiety", and "psychoticism". CONCLUSIONS: The findings show that pre-treatment facilitates the patients' approach to psychosomatic rehabilitation. Apart from receiving information patients should be motivated more strongly and their confidence in psychosomatic rehabilitation strengthened.

Appropriate use of the carbapenems.

The carbapenems are a group of broad-spectrum beta-lactam antibiotic agents of which there are three parenteral preparations currently available in South Africa, namely imimpenem/cilastatin, meropenem and ertapenem. Owing to the fact that imipenem/cilastatin and meropenem have a broad spectrum of activity that includes Pseudomonas and Acinetobacter species, they are ideal antibiotics for treatment of severe nosocomial infections. In contrast, ertapenem has limited in vitro activity against the latter non-fermentative gram-negative bacteria and is therefore more suitable for the treatment of certain severe community-acquired infections. This statement arises out of concerns about the general abuse of antibiotics such as the carbapenems, with the primary intention of highlighting the appropriate use of these agents.

Acute, persistent quinine-induced blindness. A case report.

Quinine-induced blindness arising during empirical treatment for malaria in a young man is reported. The condition was noteworthy because it was total and permanent, which is at variance with other published reports. The condition usually disappears within minutes to weeks, but persistent deficits tend to be mild and are rare. Although quinine is an essential anti-malarial agent, physicians should be fully aware of possible side-effects.

Microbiology of secondary osteomyelitis. Value of bone biopsy.

Secondary osteomyelitis occurs as a direct infection of bone from a source outside the body or as progressive and continuous spread of infection from a contiguous focus. Twenty patients with secondary osteomyelitis were studied. Pathogens were identified by culture of biopsy material from infected bone. Staphylococcus aureus accounted for most cases in the upper limbs, while infection in the lower limbs was predominantly associated with Gram-negative bacilli. The essential value of bone biopsy in treatment is emphasised.

Acute autonomic neuropathy with Salmonella typhi infection. A case report.

Acute autonomic neuropathy is a well-described clinical entity that is easy to diagnose with appropriate bedside tests. This condition is described in a patient who had a concurrent Salmonella typhi infection. The relationship between the two conditions is not entirely clear, but the simultaneous disappearance of the S. typhi from stool, the drop in Widal titres and rather early recovery of the autonomic neuropathy tend to implicate S. typhi as the causative agent.

Aspergillus brain abscess. A case report.

The history and findings in a patient with erythroleukaemia who developed a fungal brain abscess during the agranulocytic phase of induction treatment is reported. The radiological features of fungal infection are reported, with emphasis on the importance of clinical judgement in making the diagnosis. The autopsy findings further illustrate the increasing importance of this previously very rare condition.

Chloroquine-resistant Plasmodium falciparum malaria in South Africa. A case report.

Chloroquine-resistant plasmodium falciparum malaria has been described in many parts of the world, including Africa as far south as south-western Africa. We report a case of chloroquine-resistant P. falciparum cerebral malaria in the RSA. It seems likely that the infection was acquired in the Louis Trichardt district of the northern Transvaal. Despite the administration of an adequate course of chloroquine, the parasitaemia failed to clear and even increased (type III resistance). Eventually clinical and laboratory-proven cure was obtained only after combined quinine and tetracycline therapy. To our knowledge this is the first case of chloroquine-resistant P. falciparum malaria acquired in the RSA.

Cross-reacting human and rabbit antibodies to antigens of Histoplasma capsulatum, Candida albicans, and Saccharomyces cerevisiae.

Using Western blots of electrophoretically separated antigens, we show that human antibodies react most frequently to antigens shared by three fungi (Histoplasma capsulatum, Candida albicans, and Saccharomyces cerevisiae). Reactivity to antigens specific for individual fungi was relatively uncommon. The pattern of reactivity could not distinguish infected patients from uninfected controls. Rabbits immunized with extracts of each fungus also produced antibodies to cross-reactive or shared antigens of the other two fungi. Furthermore, preimmune sera showed similar but lower reactivity with the same fungal antigens. We believe that the preimmunization antibodies, which probably resulted from earlier fungal colonization or inapparent infections, predisposed the immune responses elicited by the vaccinations. A similar mechanism likely explains the results with human sera.

Probable chloroquine-resistant Plasmodium falciparum malaria in south-western Africa.

Chloroquine-resistant Plasmodium falciparum malaria has been described in East, Central and West Africa. We report on 2 patients with probable chloroquine-resistant P. falciparum malaria in south-western Africa. Both patients had been in northern SWA/Namibia and southern Angola, but had taken prophylactic chloroquine. Despite the subsequent administration of adequate courses of chloroquine therapy, the parasitaemias failed to clear completely. Eventual clinical and laboratory-proven cure was only obtained in 1 case after combined quinine and tetracycline therapy. To our knowledge, these represent the first cases of probable chloroquine-resistant P. falciparum malaria acquired in this area.

In vitro confirmation of chloroquine-resistant Plasmodium falciparum in southern Africa.

Following strong clinical evidence of the occurrence of chloroquine-resistant Plasmodium falciparum infections in southern Africa, an in vitro study on 7 P. falciparum strains yielded 2 that were considered chloroquine-resistant.