Comparison of tilt angles and provocative agents (edrophonium and isoproterenol) to improve head-upright tilt-table testing.

Patients with syncope underwent head-up tilt testing at 60 degrees and 80 degrees followed by edrophonium or isoproterenol challenge when indicated. The 80 degrees tilt protocol and edrophonium provocation were found to be as effective or more effective in eliciting neurally mediated syncope in susceptible patients.

Chronic candidal meningitis: an uncommon manifestation of candidiasis.

Chronic meningitis is an uncommon manifestation of candidiasis. We present the case of an elderly woman who had symptoms such as headache, malaise, and fever for 8 months and was found to have Candida albicans meningitis, and we review 17 similar cases. An underlying illness or risk factor for candidiasis was present in only 13 (72%) of the 18 patients. Headache, fever, and nuchal rigidity were the predominant clinical findings. Analysis of CSF showed either mononuclear or neutrophilic pleocytosis, an elevated protein level, and a decreased level of glucose. Only 17% of CSF smears were positive, and only 44% of initial CSF cultures yielded Candida species. In four cases, Candida species grew only after special techniques were used; in three cases, CSF cultures remained negative. The overall mortality associated with candidal meningitis was 53%, but among 12 patients who were treated and followed, the rate was 33%. In addition to acute meningitis seen with disseminated infection, Candida species can cause chronic meningitis that mimics tuberculosis and the more common fungal meningitides, such as cryptococcosis.

Inhibition of human red blood cell N-acetyltransferase.

Acetanilide and derivatives of benzoic acid, benzamide, salicylic acid, and salicylamide were tested as inhibitors of p-aminobenzoic acid N-acetyltransferase partially purified from peripheral blood of three rapid and two slow dapsone acetylator human volunteers. The 50% inhibition point of these compounds does not provide a kinetic basis for differentiating the rapid and slow dapsone acetylator phenotypes.

Prosthetic joint infections in the elderly.

PURPOSE: The aim of this study was to review risk factors, presenting symptoms and signs, organisms causing infection, treatment modalities, and outcomes in elderly patients with infection of prosthetic joints. PATIENTS AND METHODS: Patients over 60 years of age treated at the University of Michigan Hospital or Ann Arbor Veterans Administration Medical Center from 1977 to 1987 who had a diagnosis of prosthetic joint infection were reviewed. Early infections were defined as those occurring within 12 months of insertion of the prosthesis; late infections were those occurring more than 12 months after insertion. RESULTS: Fifty-one episodes of infection in 38 elderly patients were reviewed. There were 20 infections in prosthetic hips and 31 infections in prosthetic knees. Twenty-seven infections occurred early and 24 occurred late. Coagulase-negative staphylococci, Staphylococcus aureus, and Group D enterococci were the organisms most commonly isolated (33%, 27%, and 24% of episodes, respectively). Pseudomonas aeruginosa and other gram-negative bacilli were the causative organisms in approximately a third of the infections, and anaerobic organisms were noted in almost one fourth of episodes. In 33 episodes, the infected device was eventually completely removed, but infection resolved in only 20 of these 33 episodes (61%). In 18 episodes treated without removal of the device, none resolved. Outcome was poor; only five patients could walk without assistance, six patients developed contiguous osteomyelitis, two required amputation, and three died. CONCLUSIONS: Infection of prosthetic joints in elderly patients is a serious disease with poor functional outcome. The device has to be removed in order to clear the infection, and even then the infection is often difficult to eradicate.