Rehabilitation of therapy-related cognitive deficits in patients after hematopoietic stem cell transplantation.

Neuropsychological deficits are potential side effects of hematopoietic stem cell therapy (HSCT). Systematic data on the long-term course of and therapeutic options for these consequences are limited. One hundred fifty-seven patients were screened for cognitive deficits following HSCT for malignant diseases at an in-patient oncologic rehabilitation clinic. Patients showing evidence of impairment were randomly assigned to one of two training groups: individualized PC-supported training or neuropsychological group therapy. The control group consisted of patients who received no specific training. During in-patient rehabilitation, the results of a comprehensive neuropsychological test battery improved significantly in all three groups, and no specific intervention effects were identified. Neuropsychological deficits were still evident in a subgroup of patients 6 months later. Correlation between neuropsychological testing and patients' self-evaluation of cognitive functioning in daily life was generally low. Sustained attention and verbal-semantic memory played the main role for self-appraisal and in the designation as 'neuropsychologically impaired'. In conclusion, a substantial number of patients revealed evidence of cognitive deficits a long time after HSCT. There is a need for more studies and for the development of differentiated rehabilitative measures for such therapeutic consequences.

Leptospirosis on Oahu: an outbreak among military personnel associated with recreational exposure.

In December 1992, a common-source waterborne outbreak of leptospirosis occurred on the island of Oahu in the state of Hawaii. Two male service persons were hospitalized with culture-confirmed leptospirosis. Eighteen others had similar histories of exposure to the same freshwater swimming site. Although six men developed signs and symptoms comparable to those of the two confirmed cases, none manifested culture or serologic evidence of leptospirosis. The increased incidence of leptospirosis in Hawaii coupled with an increased risk in young males characterize the military population in Hawaii as a high-risk population with respect to leptospirosis.