Impaired nitrazepam metabolism in hypothyroidism

Delayed metabolism of a number of drugs has been described in hypothyroid patients. We report an elderly hypothyroid female who had prolonged delay in the metabolism of a commonly-used sedative, nitrazepam, and discuss the importance of delayed drug metabolism in hypothyroidism.

The elderly and their ankle jerks

The ankle jerks of 200 consecutive patients admitted to a geriatric department were assessed on the second or third hospital days by two independent observers. The test consisted of a "plantar" rather than Achilles tendon strike with a standard patellar hammer. 188 patients had ankle jerks. This finding is at variance with most previous reports on the subject. This difference may be due to, amongst other factors, the timing and method of testing.

Acute phase protein response to infection in elderly patients

The presence of infection is often difficult to diagnose in elderly patients. In view of this, laboratory markers of infection are of great clinical importance. The pattern of change in acute phase proteins has not hitherto been studied in elderly patients. In a prospective series of 114 acute elderly admissions to a Geriatric Unit there was a significant change with infection in all proteins studied, but C-reactive protein was the most sensitive marker of the presence and severity of infection and the response to antimicrobial therapy. The best pair of acute phase proteins in the prediction of infection were alpha 1-acid glycoprotein and C-reactive protein whilst albumin and alpha 1-acid glycoprotein together contributed significantly to the prediction of outcome.

Levels of cefuroxime in bronchial secretion

Levels of cefuroxime in bronchial secretion were measured in 49 patients requiring bronchoscopy for diagnostic purposes. Patients were randomly allocated to one of 4 groups which differed with respect to the size (750 mg or 1.5 g) and number (1 or 7) of intravenous doses of cefuroxime given approximately 1 hour prior to sampling. Levels of cefuroxime achieved after administration of all 4 dosages were sufficient to exceed the MIC values for the major chest pathogens. Penetration of cefuroxime into bronchial secretion was also found to be dose-related.