Simple method of detecting sarcoptes scabiei var hominis mites among bedridden elderly patients suffering from severe scabies infestation using an adhesive-tape.

OBJECT: Scabies infestation is very common among bedridden elderly patients. The standard method of diagnosis for scabies by scraping the skin requires some skill. Therefore, dermatologists employ this method. However, dermatologists are usually not present in most long-term nursing units. Thus, we tried to catch mites using a strong transparent adhesive tape commercially available for packing use as an alternative method for the diagnosis of severe scabies infestation. METHODS: After firmly applying the adhesive side of the tape onto an appropriate skin lesion of patients, the tape was pulled off and transferred directly onto a slide for microscopy, affixing the adhered separated part of the corneal skin. PATIENTS: When a massive outbreak of scabies infestation occurred in May 2004 at the nursing unit of K hospital with thirty-one bedridden elderly patients, we tried to detect scabies mite using an adhesive tape. RESULTS: We could detect mites from six patients using this tape method. The diagnosis was confirmed by the standard scraping method. By the tape method we could observe some mites moving around and also could see a striated structure with dark red or weak red color or gray color granule-like constitution on the body of some mites. We found mites only on the skin of the fingers and toes where the skin of a patient is thin. Recently, massive scabies infestation in elderly long-term residents has been reported elsewhere. This tape method is simple and useful for diagnosis of severe scabies infestation in long-term nursing units.

A Chinese patient presenting with clinical signs of fulminant type 1 diabetes mellitus.

A 31-year-old Chinese woman suffering from excessive thirst and appetite loss consulted our hospital. Laboratory examination revealed a high blood glucose level and evidence of diabetic ketoacidosis, however, the serum HbA1c was normal. The 24-hour urinary excretion of C-reactive protein and the glucagon stimulation test indicated the loss of endogenous insulin secretion. The patient satisfied the criteria for the diagnosis of fulminant type 1 diabetes mellitus. However, she tested positive for serum anti-IA2 antibody even though the titer was low. We considered it worthwhile reporting this case, because very few cases of fulminant type 1 diabetes mellitus among Chinese people have been published.

Problems in blood alcohol testing of severely injured drivers brought to emergency departments in Japan.

Breath alcohol tests are widely used to control DUI (driving under the influence) in Japan. However, this test is not applied to injured drivers transported to emergency hospitals. In such cases, BAC (blood alcohol concentration) testing should be done to prove DUI. In this paper, we tried to clarify two important issues on the BAC testing in Japan using a questionnaire survey and experiments about contamination of antiseptic ethanol. First, we have described the doctor's dilemma with DUI cases; our present questionnaire survey showed that the police often request the doctor to volunteer blood samples of the suspected drunk drivers brought to emergency hospitals since they have not been granted the right to order blood sampling in Japan. Then, doctors face a serious dilemma whether comply with the police request or not, resulting in widely different responses. Secondly, we have estimated the effects of antiseptic ethanol routinely used as a dermal antiseptic on the BAC tests. Our present experiments showed that uptake of ethanol can occur under certain conditions. Given the actual conditions outlined in the questionnaire, there seem to be a definite risk of ethanol contamination in BAC testing. Obviously, the time has come to discuss problems in BAC testing of injured drivers brought to emergency hospitals in Japan.

Norwegian scabies in an elderly patient who died after treatment with gammaBHC.

We report the first case of an elderly patient suffering from Norwegian scabies who died after treatment with gammaBHC. GammaBHC (60 mg) was applied over the entire body except for the head of a 91-year-old female in our geriatric ward. This chemical was used in a smaller dose than previously reported, and it proved to be effective except for its effect on the head. Six days after the initial application, gammaBHC (40 mg) was also applied to the patient's head, but she died 5 days later. We propose that application of gammaBHC to the head of such patients should be done with great caution.