Hypotensive syndromes are not associated with cognitive impairment in geriatric patients.

To investigate the association of the hypotensive syndromes orthostatic hypotension (OH), postprandial hypotension (PPH), and carotid sinus hypersensitivity (CSH) with cognitive impairment (mild cognitive impairment/dementia). Continuous measurements of blood pressure (Finapres) were performed during active standing, meal test, and carotid sinus massage, among 184 elderly patients presenting with falls. Mild cognitive impairment (MCI) and dementia were diagnosed following a multidisciplinary assessment. The study design was a retrospective cohort study. The OH, PPH, and CSH were observed in 104 (58%), 108 (64%), and 78 (51%) patients, respectively. A total of 79 (43%) patients were cognitively impaired (MCI impairment n = 44; dementia n = 35). The prevalence of cognitive impairment varied little across the hypotensive syndromes (32%-43%) and was similar in patients with and without hypotensive syndromes (P = .59). In this geriatric population with a high prevalence of both hypotensive syndromes and cognitive impairment, patients with one or more hypotensive syndromes were not likely to have cognitive impairment.

[Liver cirrhosis due to hepatitis E in a kidney transplant patient]. / Levercirrose door hepatitis E bij een niertransplantatiepatiënte.

Until recently, hepatitis E was considered to be an infectious disease that resolved without any long-term complications. We describe a 47-year-old woman who presented with a decompensated liver cirrhosis with ascites and peripheral oedema, 14 years after successful kidney transplantation. A previous extensive analysis of persistent liver enzyme disorders had not yielded a diagnosis, whereas now laboratory tests showed slightly abnormal liver results. The CT scan revealed ascites with signs of a decompensated liver cirrhosis. A liver biopsy revealed an active micronodular cirrhosis. Serological tests into the usual infectious causes of hepatitis provided no conclusive evidence but PCR on hepatitis E virus RNA and ELISA on virus-specific IgM and IgG were both positive on 2 occasions, suggestive for an active hepatitis E infection, the probable cause of the cirrhosis. The patient died several weeks later as a consequence of hepatic and renal failure. Hepatitis E was previously regarded as a travel-related disease from endemic areas. However, it is increasingly being observed in Western countries as well, where infection can take place due to intensive contact with animals and the consumption of infected meat.

Prevalence of psychotic disorders in patients with obsessive-compulsive disorder.

INTRODUCTION: The co-occurrence of obsessive-compulsive disorder (OCD) in patients with schizophrenia and related disorders has been increasingly recognized. However, the rate of psychosis comorbidity in OCD patients has yet to be systematically evaluated. METHODS: The prevalence of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition psychotic disorders was evaluated in 757 subjects consecutively referred to a specialised diagnostic and treatment facility for OCD. Demographic and clinical characteristics were assessed. RESULTS: Thirteen OCD patients (1.7%) also met the DSM-IV criteria for a psychotic disorder. We found no significant differences in clinical characteristic between OCD patients with and without a psychotic disorder, although patients with OCD and a psychotic disorder more likely used illicit substances and more likely were male. CONCLUSION: Relatively few patients referred to a specialized treatment OCD center suffer from a psychotic disorder.