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Urinary catheters often become encrusted and blocked by crystalline Proteus mirabilis biofilms. Results of experiments in a laboratory model of a Foley catheterised bladder infected with P mirabilis showed that when retention balloons were inflated with a solution of triclosan (10 g/L), the catheters drained freely for at least 7 days. Triclosan became impregnated throughout the silicone catheter material and completely inhibited the formation of crystalline biofilm, whereas catheters inflated with water became blocked in 24 h. Our observations suggest a way to control a common complication in patients with long-term indwelling bladder catheters. [ABSTRACT FROM AUTHOR]

Considers the rare condition of adrenocortical failure that may present with high-output cardiac failure. The experience of procalcitonin to illustrate its value in the diagnosis of acute adrenal failure indistinguishable from septic shock by routine laboratory investigation.

Questions the safety of orthochlorobenzylidene malononitrile (CS) sprays in law enforcement. Guidelines for the use of CS sprays; CS to be regarded as a drug instead of a weapon; The need for hands-on medical input and description of the effects of CS sprays; What CS sprays do to victims; Potential risks in using CS sprays.

Background: Ataxia is the commonest neurological manifestation of coeliac disease. Some individuals with genetic susceptibility to the disease have serological evidence of gluten sensitivity without overt gastrointestinal symptoms or evidence of small-bowel inflammation. The sole manifestation of disease in such patients may be ataxia. We describe the clinical, radiological, and neurophysiological features of this disorder.Methods: Patients with ataxia attending the neurology outpatient clinics at the Royal Hallamshire Hospital, Sheffield, UK, were screened for gluten sensitivity as shown by the titre of antibody to gliadin. Those with other causes of ataxia were excluded. We carried out clinical, neurophysiological, neuroradiological, and, in two cases, neuropathological examinations.Findings: 28 patients with gluten ataxia were identified. All had gait ataxia and most had limb ataxia. Those with more severe gait ataxia had longer disease duration. No patient had tremor or other extrapyramidal features. 19 patients showed some form of peripheral neuropathy on neurophysiological examination. 16 patients had no gastrointestinal symptoms. Distal duodenal biopsy showed lymphocytic infiltration in two patients, and changes compatible with coeliac disease in 11. Six patients had evidence of cerebellar atrophy on magnetic-resonance imaging. Necropsy was done on two patients who died; there was lymphocytic infiltration of the cerebellum, damage to the posterior columns of the spinal cord, and sparse infiltration of the peripheral nerves.Interpretation: Gluten sensitivity is an important cause of apparently idiopathic ataxia and may be progressive. The ataxia is a result of immunological damage to the cerebellum, to the posterior columns of the spinal cord, and to peripheral nerves. We propose the term gluten ataxia to describe this disorder. [ABSTRACT FROM AUTHOR]