Utility of scintigraphic methods in patients with fever of unknown origin

BACKGROUND: We assessed the utility of scintigraphy with indium 111-labeled polyclonal human IgG scintigraphy in patients with fever of unknown origin that fulfilled the criteria of temperature of 38.3 degrees C or more for at least 3 weeks and no diagnosis during 1 week of hospital admission. We compared the utility of this technique with results of scintigraphic techniques reported in the literature. METHODS: Data for all patients seen at our university hospital in whom 111In-IgG scanning was performed were analyzed and checked for the criteria for fever of unknown origin. The literature on the utility of scintigraphic techniques in patients with fever of unknown origin was reviewed. RESULTS: We studied 24 patients with fever of unknown origin. In 13 patients, focal 111In-IgG accumulation was observed. In nine (38%) of those, the positive 111In-IgG scintigram led to the final diagnosis; in the other four patients (17%), the scintigraphic findings were not helpful. In the 11 patients with negative 111In-IgG scans, extensive diagnostic workup produced no infection as the final diagnosis in nine patients (38%), one had an abscess in a renal cyst that was detected several months later, and in the other the cause of fever was an infected intravenous line. The overall sensitivity and specificity of 111In-IgG scintigraphy were 81% and 69%, respectively. The positive predictive value was 69% and the negative predictive value was 82%. CONCLUSIONS: Our results show that 111In-IgG scintigraphy significantly contributed to the diagnostic process in patients with fever of unknown origin. A positive scan increased the likelihood of finding the cause of the fever, and a negative scan ruled out an inflammatory component with a high degree of certainty. These data compare favorably with data in the literature concerning other radiopharmaceuticals; a larger prospective evaluation of this technique is indicated.     

Prevalence and severity of the dementia syndrome in homes for the aged and nursing homes. A study in elderly from a rural area near Zwolle

In the Netherlands both nursing homes and homes for the aged serve as a residence for demented elderly. Although these institutions differ considerably regarding financing and care facilities, specific functions of each institute concerning demented elderly have not been clearly defined. In order to know to what extent residential facilities serve demented elderly, the prevalence and severity of dementia among residents aged 65 and over was studied as part of a prevalence study among elderly people in a rural area of the Netherlands. The target population existed of all persons aged 65 and over who were registered in eight general practices. Patients who had to leave the practice on account of ill-health and were admitted to nursing homes were included in the study. In a two stage study the MMSE was applied as a screening instrument. Based on MMSE-score a non-proportional stratified random sample was drawn for the second, diagnostic stage, which existed of the CAMDEX. Prevalence estimates for DSM-III-R-dementia were 21% among residents of homes for the aged, 48% among residents of somatic wards of nursing homes and 100% among those admitted to psychogeriatric wards of nursing homes. Severity of dementia was highest among residents of psychogeriatric wards of nursing homes and lowest among those living in homes for the aged. Prevalence of dementia among residents of homes for the aged can be fully attributed to the age-distribution. The high frequency of dementia among residents of somatic nursing home wards can be explained in several ways: First, admission can be necessary due to a combination of dementia and somatic illness.(ABSTRACT TRUNCATED AT 250 WORDS)     

Porphyromonas (Bacteroides) endodontalis: its role in endodontal infections

Porphyromonas endodontalis (formerly Bacteroides endodontalis) is a black-pigmented anaerobic Gram-negative rod which is associated with endodontal infections. It has been isolated from infected dental root canals and submucous abscesses of endodontal origin. The presence of P. endodontalis in infected dental root canals has been correlated with symptoms of an acute infection. It is occasionally found on oral mucous membranes and periodontal pockets. P. endodontalis has shown relatively low virulence in experimental monoinfections. In anaerobic mixed infections it can play an essential role. Differences in virulence between strains have been related to capsular material. On the basis of different types of capsules, three serotypes have been described. P. endodontalis is sensitive to a wide range of antibiotics, including the penicillins, the tetracyclines, and metronidazole.     

A three-dimensional iterative scheme for an electromagneticinductive applicator

An efficient iterative method for solving quasi-static electromagnetic field problems is presented. The electromagnetic field is generated by an inductive applicator and is represented as a superposition of two constituents, viz. a primary field in absence of the tissue configuration and a secondary field generated by the presence of the tissue. Then, for the secondary field a quasi-static approximation is employed. In the quasi-static field equations a relaxation function is introduced, such that the resulting equations can be solved iteratively. For a realistic three-dimensional model of a human hand numerical results are presented.     

A Genetic Dissociation of Learning and Recall in Caenorhabditis elegans.

A learning event can be dissociated into 3 components: acquisition, storage, and recall. When the laboratory wild-type strain of Caenorhabditis elegans (N2 strain) is exposed to benzaldehyde in the absence of food, the worms display a reduction of their attractive response to this volatile odorant. This results from the association between benzaldehyde and a nutrient-deficient environment. Another wild-type isolate, the CB4856 strain, fails to display this decreased response to benzaldehyde after exposure to benzaldehyde in the absence of food. However, like the N2 strain, when tested to isoamyl alcohol after benzaldehyde conditioning, the CB4856 strain displays a decreased isoamyl alcohol response. Therefore, the CB4856 strain does not have an acquisition deficit, but it suffers from a recall deficit specific to benzaldehyde. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

New climate change scenarios for the Netherlands.

A new set of climate change scenarios for 2050 for the Netherlands was produced recently. The scenarios span a wide range of possible future climate conditions, and include climate variables that are of interest to a broad user community. The scenario values are constructed by combining output from an ensemble of recent General Climate Model (GCM) simulations, Regional Climate Model (RCM) output, meteorological observations and a touch of expert judgment. For temperature, precipitation, potential evaporation and wind four scenarios are constructed, encompassing ranges of both global mean temperature rise in 2050 and the strength of the response of the dominant atmospheric circulation in the area of interest to global warming. For this particular area, wintertime precipitation is seen to increase between 3.5 and 7% per degree global warming, but mean summertime precipitation shows opposite signs depending on the assumed response of the circulation regime. Annual maximum daily mean wind speed shows small changes compared to the observed (natural) variability of this variable. Sea level rise in the North Sea in 2100 ranges between 35 and 85 cm. Preliminary assessment of the impact of the new scenarios on water management and coastal defence policies indicate that particularly dry summer scenarios and increased intensity of extreme daily precipitation deserves additional attention in the near future.     

Investigation of bounds on particle packing in pebble-bed high temperature reactors

Models and methods are presented for determining practical limits of the packing density of TRISO particles in fuel pebbles for a pebble-bed reactor (PBR). These models are devised for designing and interpreting fuel testing experiments. Two processes for particle failure are accounted for: failure of touching particles at the pressing stage in the pebble manufacturing process and failure due to inner pressure buildup during irradiation. The second process gains importance with increasing fuel temperature, which limits the particle packing density and the corresponding fuel enrichment. Suggestions for improvements to the models are presented.