There has been a surge of interest regarding the benefits of vitamin D supplementation to prevent fractures. But can it also make them heal more quickly once they have occurred-that is, is supplementation of vitamin D beneficial for fracture healing? We found 13 studies that met our inclusion criteria, 11 of these were performed in animals. Two animal studies showed negative, 2 neutral, and 7 positive results. One clinical case series in humans was inconclusive in our opinion, and one randomized double-blind placebo-controlled trial showed that supplementation of vitamin D 3 and calcium in elderly women with reduced bone mass and a proximal humerus fracture had a positive influence on bone healing. The major weakness of the latter study is low number of participants. A clear statement on the benefits of vitamin D for fracture healing awaits further trials, but all types of fractures in elderly individuals indicate the need for secondary prevention and the implementation of appropriate guidelines concerning falls, vitamin D, and osteoporosis.
We describe a patient who experienced recurrent episodes of abdominal pain as a prominent feature of his seizure disorder. Treatment with carbamazepine could not prevent these painful sensations, but a selective amygdalohippocampectomy completely controlled the episodic pain and the seizures associated with loss or alteration of consciousness. During the presurgical evaluation, the episodes of abdominal pain correlated with amygdalar seizure discharges.
Cancer is an independent risk factor for ischemic stroke, and stroke can precede tumour diagnosis by many months. A paraneoplastic hypercoagulability has been implicated. Overall, cancer is a rare cause, but should be suspected in cases of cryptogenic stroke. In patients with cryptogenic stroke, two criteria – ischemic lesions in multiple vascular territories and D-dimer values >2,15 µg/ml – predict cancer with 100% specificity according to one relevant study. An adenocarcinoma at an advanced stage is identified in many cases, the risk of stroke-recurrence is high. There is a lack of evidence-based recommendations regarding secondary prevention in these cases. In analogy to the guidelines for venous thromboembolism in cancer patients, low molecular weight heparins might be more efficient compared to other anti-clotting agents.
50 year-old man with fever and headache starting one week after returning from his vacation in Thailand. His general practitioner prescribed amoxicillin/clavulanic acid, without further analyses to pinpoint the infection. The examination of cerebro-spinal fluid was crucial for the final diagnosis. Lumbar puncture demonstrated a predominantly mononuclear pleocytosis of 80 cells/µl (< 5) with an elevated protein of 782 mg/l (< 450); glucose and lactate were within normal limits. Initially we tried to treat a broad range of organisms potentially causing meningitis or encephalitis. Typical bacteria and viruses endemic to Switzerland were not found, thus anti-infective treatment was stopped. Also the search for malaria, HIV, Chikungunya and Dengue infections yielded negative results. After 10 days we received a positive serologic test for Japanese encephalitis virus (JEV). The Japanese encephalitis virus is transmitted by mosquitoes and is epidemiologically one of the most important transmissible neurologic diseases in Asia. Although only a minority of infected patients are gravely ill, their sequelae and death toll are considerable. Since 2009 a well-tolerated vaccine is available.
Patients with Parkinson's disease or parkinsonism are hospitalized more frequently, suffer more complications, have longer inpatient stays and are less frequently discharged directly to home. Their medication is often discontinued during hospitalization, leading to numerous complications such as akinetic crises with more falls, pressure ulcers, pulmonary problems, need for more nursing care, etc. There are various methods to overcome swallowing difficulties, and thus sustain the necessary level of dopaminergic stimulation. Commonly used anti-dopaminergic drugs to treat nausea or confusion have to be avoided.
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