Caregiver time use in ALS.

The authors evaluated the caregiver time for 70 patients with ALS. The mean number of caregivers per patient was 2.0 (SD 1.3). Caregiver time increased with worsening of disability (p = 0.0001). The most time-consuming duties were housekeeping, feeding, and toileting. With worsening of patients' disability, families relied increasingly on paid caregivers. Caregiver time is a hidden cost of ALS care and is a major burden for caregivers.

Percutaneous radiological gastrostomy: a safe and effective method of nutritional tube placement in advanced ALS.

BACKGROUND: Enteral nutrition may be required in amyotrophic lateral sclerosis (ALS), and is usually achieved by percutaneous endoscopic gastrostomy (PEG). As PEG is not indicated in patients with severe respiratory impairment, an alternative is percutaneous radiological gastrostomy (PRG), involving air insufflation into the stomach under fluoroscopic guidance for tube insertion. OBJECTIVE: To evaluate the safety of PRG and its effect on survival and respiratory function in ALS patients with respiratory failure. METHODS: 25 consecutive ALS patients with severe dysphagia and forced vital capacity (FVC) <50% underwent PRG after October 2000. They were compared with 25 consecutive ALS patients with FVC <50% who underwent PEG before October 2000. Respiratory function was evaluated before and after the procedure. RESULTS: The two groups were similar for all relevant characteristics. PRG was successful in all cases, PEG in 23/25. One patient in each group died after the procedure. The mean survival time after the procedure was 204 days in the PRG group and 85 days in the PEG group (p<0.004). Respiratory function decreased more in the PEG group than in the PRG group (p<0.02). CONCLUSIONS: PRG appears to be safer than PEG in ALS patients with moderate or severe respiratory impairment, and is followed by a longer survival.

Amyotrophic lateral sclerosis among the migrant population to Piemonte, northwestern Italy.

Recent surveys indicate a decreasing north-to-south gradient in the mortality and incidence rates of amyotrophic lateral sclerosis (ALS) in Italy, possibly indicating a different susceptibility to ALS in these populations. Piemonte, a region of northwestern Italy, experienced a considerable migration from other regions in Italy between 1940 and 1975; we therefore analyzed the effects of place of birth and migration upon the risk of developing ALS. Data on all ALS cases occurring in Piemonte during the period 1971-1990 were collected. Standardized incidence ratios (SIRs) for patients born outside Piemonte were calculated, using the Piemonte-born population as reference. A total of 962 ALS cases were identified during the study period, corresponding to a mean annual crude incidence rate of 1.37/100,000 population (95% confidence interval, 1.29-1.46). The SIRs of patients born in three southern Italian regions and of foreign-born persons were significantly higher than those of persons born in Piemonte and or other regions in Italy, and increased with age. This observation may be explained by an interaction between environmental and genetic factors or by selective migration.

Reduced glutathione in amyotrophic lateral sclerosis: an open, crossover, randomized trial.

The present study set out to define the possible effect of reduced glutathione (GSH), the substrate of glutathione peroxidase (GSH-Px), a free radical inactivating enzyme, in amyotrophic lateral sclerosis (ALS). Thirty-two patients affected by definite ALS seen in our institution between August 1993 and July 1994 were admitted to the study. The effect of GSH was studied in an open, crossover, randomized study. GSH was given at the dose of 600 mg each day intramuscularly for 12 weeks. The patients, taken sequentially, were randomly assigned to two groups. The first group received the drug while the second received only symptomatic therapies for 12 weeks. After a week of washout, the second group received GSH and the first only symptomatic therapies for 12 weeks. The rate of progression of the diseases was compared in the two groups. Clinical evaluation included manual test for muscle strength, Norris scale, bulbar scale, and forced vital capacity (FVC) percent. No significant difference was found in the progression of ALS in the two periods, although a slight slowing of the disease progression rate was found during the period of treatment, probably related to the open design of the study. Our data do not show any significant effect of reduced glutathione in modifying the progression of ALS.

Disseminated Dactylaria gallopava infection in a diabetic patient with chronic lymphocytic leukemia of the T-cell type.

A 62-year-old male with a 20-year history of diabetes and three-year history of adult T-cell lymphocytic leukemia developed a systemic infection with Dactylaria gallopava. At autopsy the fungus was found in the brain, lungs, liver, spleen, and kidney. The organism has caused disease in chickens and turkey poults and has been found in chicken litter, hot springs, and the effluent of a thermonuclear reactor. This report documents the second human infection and the first case of disseminated human dactylariosis.

Candida lusitaniae septicemia in a patient on extended home intravenous hyperalimentation.

This is a report of the successful therapy of a case of Candida lusitaniae septicemia in a patient with short bowel syndrome who had been on home intravenous hyperalimentation for approximately 3 months when the infection developed. C. lusitaniae was isolated from multiple blood cultures taken over the course of 2 days.

Red-pigmented Histoplasma capsulatum--an unusual variant.

An unusual variant of Histoplasma capsulatum was isolated from a canebrake. The mycelial form produced a red pigment that diffused into the medium and which was also present in the cell walls of the mycelium, microconidia and macroconidia. The yeast cells were not pigmented nor did they produce any pigment.

Epidermophyton floccosum infection in a dog from the United States.

Epidermophyton floccosum was isolated from a lesion of dermatophytosis on a dog with hyperadrenocorticism. This report is, to our knowledge, the first unequivocally documented case of canine infection in the United States.

Evaluation of commercial reagents to identify the exoantigens of Blastomyces dermatitidis, Coccidioides immitis, and Histoplasma species cultures.

Commercially available individual serologic reagents (Nolan/Scott Biological Laboratories, Inc.) and an "exoantigen identification system" (a kit supplied by Immuno-Mycologics, Inc.) were evaluated at two laboratories for their possible application in the microimmunodiffusion test to identify Blastomyces dermatitidis, Coccidioides immitis, and Histoplasma species. Both laboratories accurately identified all the cultures, and comparison of the results obtained with the commercial products and those established with the conventional methods performed by a third control laboratory demonstrated full agreement. The use of these two commercial products is recommended for the immunologic identification of cultures suspected of being B. dermatitidis, C. immitis, and Histoplasma species. It was observed, however, that the exoantigen reactions for four B. dermatitidis and two C. immitis isolates were much sharper and more readable with the individual reagents than the reactions observed with the kit.

Use of the exoantigen test to identify blastomyces dermatitidis, coccidioides immitis, and Histoplasma capsulatum in mixed cultures.

Cultures of Blastomyces dermatitidis, Coccidioides immitis, and Histoplasma capsulatum were inoculated with each of five saprophytes to simulate contaminated cultures. The cultures were extracted and tested in the immunodiffusion exoantigen test. Twenty-nine of 30 cultures were correctly identified. The saprophytes did not appear to interfere with the exoantigen test.