Emergency department presentations of typhoid fever.

Typhoid fever, a systemic infectious disease caused by Salmonella typhi, is classically characterized by fever, paradoxical bradycardia, abdominal pain, and a rose colored rash. This was a retrospective review of 21 confirmed cases over a 5-year period. Mean age was 32.6 years (range 2-60 years), and Mexico (7/21) and El Salvador (3/21) represented the most common countries of origin. Recent travel to an endemic area was noted in 14 patients. The most common complaints were fever (15/21), headache (10/21), abdominal pain (9/21), and diarrhea (6/21). Average duration of symptoms before presentation to the Emergency Department (ED) was 7.9 days. High fever associated with bradycardia was noted in 12 patients. Leukopenia was present in 7 patients. Blood culture was the most sensitive confirmatory test while the Widal test was positive in 7 out of 11 cases. Fever of unknown origin (12/21), followed by presumed typhoid fever (3/21) were the most common ED diagnoses. It is important to recognize that patients with typhoid fever may present to EDs in the US and this disease should be included in the differential diagnosis of febrile patients from Latin America or those with a history of recent travel to endemic countries.

Sinonasal lymphoma.

The clinical course of 49 patients with the diagnosis of non-Hodgkin's lymphoma were studied in the Department of Otolaryngology of the Hospital General de Mexico between December 1986 and March 1997. The most frequent clinical symptoms in these patients were: nasal obstruction, rhinorrhea, fever, weight loss, cervical lymph adenopathy, rhinopharyngeal tumor, ulceration on the palate and periorbital cellulitis. In 73% of the patients in this series the primary presentation was nasal. Sixty-six percent of the patients were classified as intermediate grade lymphoma according to the New Working Formulation, and 33% were in a I B state according to the Ann Arbor predominant immunotype was B cell in 63% of the cases. An extensive review of the literature is also presented.

Recombinant methioninase infusion reduces the biochemical endpoint of serum methionine with minimal toxicity in high-stage cancer patients.

The tumor-specific increased minimal requirement for methionine has been shown to be a highly promising therapeutic target. To attack this target we have previously cloned the methioninase gene from Pseudomonas putida and produced recombinant methioninase (rMETase). A pilot Phase I clinical trial has been carried out to determine rMETase toxicity, rMETase pharmacokinetics, and serum MET-depletion in cancer patients. Patients with advanced breast cancer, lung cancer, renal cancer and lymphoma were given a single rMETase treatment at doses ranging from 5,000 to 20,000 units by i.v. infusion over 6-24 hours. No clinical toxicity was observed in any patient after rMETase treatment. rMETase levels reached 0.1 to 0.4 units per ml of serum in the patients which correspond to therapeutic levels in vitro. The lowest serum methionine levels in rMETase-treated patients were 0.1% of the pre-treatment levels corresponding to approximately 0.1 microM, which also correlates to therapeutic levels in vitro. The results of the rMETase pilot Phase I clinical trial therefore indicate that i.v. infusion of rMETase is safe and effectively depletes its biochemical target of serum methionine suggesting potential efficacy in future clinical trials.

[Chagas disease in Guerrero. Report of 2 cases confirmed with xenodiagnosis]. / Enfermedad de Chagas en Guerrero. Reporte de dos casos confirmados con xenodiagnóstico.

We report two cases of patients from Costa Chica of Guerrero state, Mexico, with cardiologic problems compatible with Chagas disease. The serologic studies were positive for Indirect Haemagglutination and Immunofluorescence tests. The infection was confirmed with xenodiagnostic using Triatoma mazzotti nymphs.

Computed tomography of the cervical carotid artery: significance of the lucent defect.

To investigate the clinical significance of lucent defects in computed tomography (CT) scans of the cervical carotid artery plaque, we studied 95 patients with recent symptoms of hemispheric ischemia. Using multiple linear regression analysis, we estimated the strength of the association of symptoms with laterality of carotid artery lucent lesions, stenoses, and ulcerations observed in CT scans. Hemispheric symptoms correlated strongly with ipsilateral carotid lucent lesions (partial p less than 0.025) and with ipsilateral severe (greater than 75%) carotid stenosis (partial p less than 0.025). Carotid artery ulcerations had a weaker association (partial p less than 0.1), and stenoses of mild and moderate degrees showed none. The overall performance of all three plaque complications was highly significant (p less than 0.005). The lucent defect indicates a morphologic change in the carotid plaque that plays an important role in the development of symptoms of hemispheric ischemia. This is in agreement with the notion that the lucent defect is the image of intraplaque hemorrhage and/or necrosis, which are complications central to the development of symptomatic carotid disease.

Intestinal enzymes: indicators of proliferation and differentiation in the jejunum.

Some intestinal enZymes were assayed which were related to: (i) Cellular proliferation, for example, aspartate carbamoyltransferase, thymidine kinase, uridine kinase, and dihydroorotase; (ii) cellular differentiation, for example, lactase, invertase, maltase, alkaline phosphatase, and dipeptidase; and (iii) lysosomes, for example, beta-glucuronidase, acid beta-galactosidase, and acid phosphatase. These enzymatic determinations can be used to distinguish the crypt from the villus during healthy or diseased states.