Polyneuropathy in Australian outpatients with type II diabetes mellitus.

In order to determine the local prevalence of polyneuropathy among adult outpatients with type II (non-insulin-dependent) diabetes mellitus, we applied a series of standardised measures to patients attending a multidisciplinary diabetes clinic. The study group comprised 94 men and 15 women; mean age, 70.6+/-7.8 years; mean duration of diabetes, 11.7+/-10.1 years; and mean HbA1c 8.3%+/-1.7%. Neuropathy Symptom Scores > or = 1 were present in 97% of patients (mean, 3+/-2; range, 0-12), and 95% had Neuropathy Disability Scores > or = 2 (mean, 27+/-19; range, 0-87). 52% of men reported impotence. Autonomic dysfunction on cardiovascular reflex testing was present in 46% of patients (39/84). Finger and toe vibration perception thresholds were greater than 3SD higher than mean thresholds measured in control subjects without diabetes in 43% and 58% of patients, respectively. Polyneuropathy, defined as lower limb sensory and motor nerve conduction velocity or latency outside mean +/-2 SD of that measured in age-matched controls, was present in 49% of patients (53/109). These results suggest that there is a high prevalence of polyneuropathy in Australian out-patients with type II diabetes mellitus. In this study, clinical assessment using Neuropathy Disability Scores was not diagnostically useful since only five patients had a normal score. Using nerve-conduction studies as the "gold standard" diagnostic criteria, the best alternative test for the presence of polyneuropathy was toe vibration perception threshold (sensitivity 74%, specificity 56%). In view of the emerging evidence that intensive glycaemic control reduces the rate of progression of polyneuropathy, we recommend that patients with type II diabetes mellitus have nerve-conduction studies performed for early detection of this important complication.

Optic disc oedema and diabetes mellitus: a case report with review.

Optic disc oedema is a neurological complication of diabetes mellitus. Typically, the patient is a young diabetic with minimal symptomatology but severe bilateral optic disc oedema discovered on routine eye examination. It is a relatively benign condition which on occasion can result in a residual visual deficit, but requires no specific intervention and represents a subgroup of anterior ischaemic optic neuropathy (AION). We present a patient with insulin dependent diabetes and asymptomatic bilateral optic disc oedema, with a brief review of the syndrome and its pathogenesis.

A case of herpes zoster associated encephalitis treated with acyclovir.

The case of a 67 year old male who developed severe encephalitis associated with herpes zoster ophthalmicus is described. Encephalitis occurred in the absence of cutaneous dissemination and recovery followed treatment with Acyclovir.

Cryptococcal meningitis. A review of 32 years experience.

This study is a review of cryptococcal meningitis in Queensland, Australia, with particular reference to changes in incidence, methods of diagnosis and treatment and their effects on mortality and morbidity over the past three decades. Cryptococcal meningitis remains more prevalent among males, and aborigines. Mortality has declined dramatically since 1948, due to the use of the specific antifungal agents amphotericin B, flucytosine, and more recently miconazole. The availability of cranial computerized axial tomography and the early treatment of hydrocephalus have significantly contributed to the overall management of these patients. 75% of patients receiving a full course of treatment can now be expected to make a satisfactory recovery.

Cryptococcal meningitis: treatment of three patients with miconazole.

Three patients with cryptococcal meningitis who were treated with miconazole are reported. All patients had previously received combination therapy with amphotericin B and flucytosine which was unsuccessful. All patients showed clinical improvement, and one obtained a mycological remission. Miconazole was well tolerated, and would appear to be a relatively non-toxic and effective drug in the treatment of cryptococcal meningitis which is refractory to conventional chemotherapy.

High performance liquid chromatographic assay of dexamethasone in plasma and tissue.

Dexamethasone in plasma and in tissue is specifically quantitated by high performance liquid chromatography (ultraviolet detection at 254 nm) with an octadecyl silane reversed-phase chromatographic column employing peak-height ratio determination (internal standard, cyheptamide). The sample is first washed with heptane under alkaline conditions. The dexamethasone is then extracted from the washed sample with dichloromethane containing the internal standard. Dichloromethane is evaporated to dryness, and the concentrated extract is dissolved in tetrahydrofuran and then injected into a high performance liquid chromatograph. Dexamethasone and internal standard are eluted with a mixture of acetic acid, methanol, butanol, and water (11/19/30/440 by volume). Sensitivity limit is 10 ng, with linear response to at least 1.000 mg/liter plasma. Analytical recovery of dexamethasone from plasma is almost complete, and approximately 87% dexamethasone is recovered from brain tissue. Intra-assay precision (CV) is 1.07% (N = 11), and interassay precision is 1.38% (N = 5). No interference occurred in plasmas from patients treated with various drugs other than dexamethasone. Dexamethasone was estimated in plasma and in tumor tissue from patients on dexamethasone therapy.