No abstract

We demonstrated that, despite positive intentions of physicians, the biochemical monitoring recommendation in patients treated with RASIs is poorly met. In addition, serum creatinine monitoring was significantly less often performed in high-risk patients compared with low-risk patients.

Pulmonary embolism (PE) is a potentially severe diagnosis with high short-term mortality. Recently, age-adjusted cut-off values (age × 10 μg/l) of D-dimer were introduced to improve the diagnostic workup in older patients. In clinical practice, PE is considered 'ruled out' in patients with a non-high clinical probability and a normal D-dimer. However, all diagnostic tests have a small false-negative rate. This small probability of misdiagnosis might be easily overlooked by clinicians when using simplified dichotomized flow charts. This case illustrates a normal D-dimer (age-adjusted) but with a PE. We recommend clinicians using the D-dimer test-either conventional or age-adjusted in a rule-out strategy to be aware of the-albeit small probability of a false-negative result.

Peripheral antidopaminergic medication is frequently prescribed to treat nausea. However, domperidone is ill-famed for its severe cardiac adverse effects. Metoclopramide has been suggested as a relatively safe alternative because it has long been considered to have less significant cardiovascular adverse effects. We present an older patient who developed severe bradycardia and hypotension shortly after receiving intravenous metoclopramide. Cardiac adverse effects of metoclopramide in elderly are not frequently described in the literature, especially not in patients without a major history of cardiac disease. We recommend caution with intravenous administered metoclopramide in older patients.

Diagnosis of Asperger Syndrome in a 66-year-old male presenting with depression Asperger Syndrome (AS) is an uncommon condition which is a part of the autistic spectrum disorders group. This condition, first described in 1944 by Hans Asperger was characterized by problems in social integration, verbal communication, empathy and preoccupation with unusual interests (Fitzgerald and Corvin, 2001). Several diagnostic criteria are currently used to diagnose AS, including the ICD-10 (World Health Organization, 1992) and the DSM-IV (American Psychiatric Association, 1994), but those proposed by Gillberg are probably closest to Asperger's original description (Fitzgerald and Corvin, 2001). Both the ICD-10 and the DSM require the presence of normal speech and IQ to be present from early life. Gillberg's diagnostic criteria include social impairment, narrow interests, repetitive routines, speech and language peculiarities, non-verbal communication problems and motor clumsiness (Ehlers and Gillberg, 1993). We report a case of AS that was diagnosed in a 66-year male patient following his referral to old age psychiatry services for depression. He gave written informed consent to the publication of this letter. A 66-year old Caucasian male was referred to our old age psychiatry department with low mood, irritability, occasional bad temper and withdrawal from the family. On referral he was on Citalopram 60 mg with modest response. As a child he did well at school, but did not mix with others. He had never been good at sport and had never been able to learn to ride a bike. He described himself as bit of a loner and enjoyed his job as a postal worker as this gave an opportunity to enjoy his fascination with numbers. He avoided working in a sorting office because he liked his own company. There was a long history of obsessional traits involving numbers. He was happiest when on his own or listening to his music, and used to collect ties, even though he did not wear them. He expressed difficulties in coping with change and operated within rigid routines. He became upset when his routine was disturbed, for example when his grandchildren were visiting. His family found that he tended to lash out when out-of-doors, particularly in crowds. On interview he admitted to low mood, reduced appetite, insomnia and poor memory. On mental state examination, there was decreased facial expression with occasional smiles. His conversation was circumstantial, with