[Diagnosis and treatment of orbital cellulitis]. / Diagnostiek en behandeling van orbitale cellulitis.

Orbital cellulitis is a rare disease usually caused by sinusitis. Generally, the prognosis of both preseptal cellulitis and orbital cellulitis is favourable. Radiological distinction should be made between an orbital abscess and subperiosteal empyema. Theoretically, empyema is more accessible to antibiotics and, as it arises in a pre-existing anatomical space, it needs less aggressive treatment than an abscess. In contrast, the wall of an abscess created by the bacteria is scarcely permeable to antibiotics. Indications for surgical drainage should be based on clinical findings and not on Chandler's classification. Loss of vision, an unresponsive pupil or a densely packed orbit are indications for immediate surgical drainage. Drainage of an orbital abscess may speed up recovery.

Incidental head and neck findings on MRI in young healthy volunteers: prevalence and clinical implications.

We determined the prevalence and clinical relevance of incidental brain and head and neck findings in young healthy volunteers with MR imaging. We retrospectively analyzed the MR images obtained from 203 healthy young adult volunteers (mean age, 21.9 years; range, 18-35 years). The prevalence of the categories of findings (no referral necessary, routine referral, urgent referral, and immediate referral) was scored by a head and neck radiologist or neuroradiologist. We found a high prevalence of incidental brain and head and neck abnormalities (9.4% and 36.7%, respectively); 4.4% of the brain findings and 5.5% of the head and neck findings were classified as in need of referral. Only 1 incidental finding classified as in need of referral (a skull lesion consistent with fibrous dysplasia) was actually referred at the time of the study (5.2%). These findings suggest that a high prevalence of incidental findings is common in healthy young volunteers, though the clinical implications are negligible.

Serotonin and dopamine transporters in relation to neuropsychological functioning, personality traits and mood in young adult healthy subjects.

BACKGROUND: Serotonin and dopamine neurotransmitter systems are implicated in the regulation of mood, cognition and personality traits and their dysfunction is thought to be implicated in diverse psychopathologies. However, in healthy subjects the relationship between the serotonin and dopamine systems and neuropsychological functioning and personality traits is not clearly established. In the present study we investigated whether neuropsychological functioning, personality traits and mood states of a group of healthy subjects are associated with in vivo measures of serotonin transporters (SERTs) and dopamine transporters (DATs). METHOD: A total of 188 young healthy subjects underwent neuropsychological and subjective measurements of memory function, depression and impulsivity. Participants' SERT and DAT availability in predefined regions of interest were assessed using single photon emission computed tomography (SPECT) with the radiotracer [123I]ß-CIT. Individual magnetic resonance imaging (MRI) scans served as anatomic reference. RESULTS: We did not find any significant association between SERT or DAT availability and neuropsychological test performance or self-reported impulsivity and mood. There were no significant sex differences in SERT or DAT availability, but men performed significantly better on some tests of visuospatial functioning than women. CONCLUSIONS: Robust negative findings for striatal DAT availability seriously question earlier findings of positive associations between DAT availability and cognitive functions in healthy subjects. Our results also suggest that subcortical SERT availability is not associated with the neuropsychological functions and personality traits assessed. In summary, the present study suggests that neuropsychological and personality measurements in young healthy people are not associated with subcortical SERT or striatal DAT availabilities in the brain.

Specific effects of ecstasy and other illicit drugs on cognition in poly-substance users.

BACKGROUND: A large number of studies, reviews and meta-analyses have reported cognitive deficits in ecstasy users. However most ecstasy users are polydrug users, and therefore it cannot be excluded that these deficits are (partly) the result of drugs other than ecstasy. The current study, part of the Netherlands XTC Toxicity (NeXT) study, investigates the specific sustained effects of ecstasy relative to amphetamine, cocaine and cannabis on the brain using neuropsychological examination. METHOD: A stratified sample of 67 subjects with such a variation in type and amount of drug use was included that correlations between the consumption of the various drugs were relatively low allowing stepwise linear multiple regression analyses to differentiate between the effects of ecstasy and those of other substances. Subjects were assessed with neuropsychological tests measuring attention, working memory, verbal and visuospatial memory, and visuospatial ability. RESULTS: Ecstasy use [mean 327 (S.D.=364) tablets in lifetime] had a specific significant dose-related negative effect on verbal delayed recall after adjusting for the use of other drugs. CONCLUSIONS: These findings strongly suggest a specific sustained negative effect of ecstasy use on verbal memory. The clinical relevance is not immediately clear, because test performance generally remained within the normal range. However the magnitude of the effect is substantial (d>0.5) and long-term consequences cannot be excluded.

An integrated drug prescription and distribution system: challenges and opportunities.

Using the hospital's drug prescription and distribution system as a guide, benefits and drawbacks of a medical activity management system that is tightly integrated with the supply chain management of a hospital will be discussed from the point of view of various participating healthcare actors.