[Tuberculous meningitis in review].

Tuberculosis meningitis is one of the most dangerous forms of tuberculosis (TB). Due to large waves of immigration, the incidence of TB in Israel has increased in recent years, as has that of TB meningitis. Due to its high mortality, rapid diagnosis of TB meningitis is of paramount importance. We present a patient admitted with a acute febrile disease which was subsequently diagnosed as TB meningitis.

[Cerebellar infarction, clinical presentation, diagnosis and treatment].

Cerebellar infarction is relatively infrequent and accounts for about 2% of all strokes. Its clinical presentation and course are variable. It may resemble vestibulitis in mild cases, but the presentation may be more dramatic in other cases. Cerebellar infarction may cause life-threatening complications such as acute hydrocephalus or brain stem compression, resulting from their mass effect in the posterior fossa or extension of the infarct to the brain stem. Clinical features alone are insufficient for the diagnosis and for follow-up of patients with cerebellar infarction. However the advent of CT and MRI and their availability enable early diagnosis of cerebellar infarction, and early recognition of the development of acute hydrocephalus or brain stem compression which require surgical decompression. The prognosis of most cases is good when treatment is appropriate.

Health effects of cigarette smoking.

Cigarette smoking, the chief preventable cause of illness and death in the industrialized nations, is a major contributor to morbidity and mortality from cardiovascular and respiratory diseases. It is also the most important preventable factor in the development of lung cancer and various other malignancies, and it may also have a significant role in the pathogenesis of other diseases. Cigarette smoking, the leading cause of morbidity, disability, and death in the Western world, may be considered the most serious pandemic of our century.

Second primary cancer of the larynx in patients with lung cancer.

Synchronous or metachronous second primary malignancies of the lung are sometimes encountered in patients with laryngeal cancer while the occurrence of a laryngeal second primary following cancer of the lung is rare. A two-armed study was conducted. A prospective arm in which the larynges of 56 terminal lung cancer patients were examined, and a retrospective arm incorporating both a chart study of 126 terminal head and neck cancer patients (HNCP) and a computerized search of all hospital records of patients with laryngeal and lung cancers. No laryngeal malignancy was found in the lung cancer patients' group and no antedating pulmonary malignancy was recorded in the terminal HNCP. The computerized search of 1778 lung cancer patients and 213 laryngeal cancer patients also failed to demonstrate cases where the former preceded the latter. In conclusion. No second primary of the larynx was found in lung cancer patients. These results compare with reports of large databases where cancer of the larynx was found in a negligible percentage of lung cancer survivors and theories explaining this are discussed.

Successful treatment of early secondary myelofibrosis in SLE with IVIG.

Myelofibrosis has been reported as a rare cause of pancytopenia in patients with autoimmune diseases. We describe a 54y old female patient who was admitted with severe anemia subsequently found to be due to marrow fibrosis. During the course of her hospitalization, relying both on her clinical symptoms as well as the results of a wide range of laboratory tests and diagnostic procedures, the diagnosis of systemic lupus erythematosus was established. The patient was treated with high dose steroids, but improvement of her clinical symptoms as well as normalization of her peripheral blood count were achieved only after high dose intravenous therapy with gamma globulin (IVIG) was instituted. Along with the improvement in the peripheral blood parameters normalization of the bone marrow architecture was recorded on a repeated bone marrow biopsy. IVIG therapy should be considered in extreme cases of bone marrow suppression in SLE.

Survival in miliary tuberculosis complicated by respiratory distress.

An immigrant from India presented with a three months history of fever, weight loss, cough and hepatomegaly which were rapidly diagnosed as miliary tuberculosis when gastric lavage revealed acid-fast bacilli. One day after antituberculous therapy was commenced, the patient developed adult respiratory distress syndrome and disseminated intravascular coagulation which were successfully treated by corticosteroids, fresh frozen plasma and mechanical ventilation. Ten other survivors of miliary tuberculosis and adult respiratory distress syndrome were reviewed and the association of adult respiratory distress syndrome with the antimicrobial therapy is discussed.

Diurnal changes in plasma lipoproteins of free-living healthy men consuming a standard diet.

Although it is well established that plasma lipoproteins are involved in atherogenesis, most patients with coronary heart disease have normal or nearly normal fasting plasma lipid and lipoprotein levels. As most of the human life is spent in the fed state we elected to investigate the changes occurring in plasma lipids and lipoproteins during normal daily activities. We studied 12 healthy, normolipidemic and non-obese subjects on a standard diet divided into three meals and three snacks. This method was found to be accurate and reproducible in four subjects who underwent repeated studies. The major diurnal changes were observed in plasma triglyceride level and in the composition of plasma lipoproteins. The degree and pattern of these changes differed among subjects but was specific and constant for each individual. The extent of these diurnal changes, which correlated positively with fasting plasma triglyceride and inversely with plasma HDL2 levels, may play an important role in the pathogenesis of atherosclerosis.

Efficacy and safety of pravastatin once daily in primary moderate hypercholesterolemia: the Israeli experience.

Seventy-seven hypercholesterolemic patients participated in a 26-week, multicenter, randomized, double-blind, placebo-controlled study that investigated the efficacy and safety of pravastatin therapy. All patients had primary moderate hypercholesterolemia (total cholesterol 200-300 mg/dl, at the end of a 6-week dietary run-in period) and two additional coronary risk factors. Pravastatin, 20-40 mg/day given at bedtime, reduced total cholesterol by 19-22%, LDL-cholesterol by 24-30%, triglycerides by 10-30% and increased HDL-cholesterol by 9-13%. The drug caused mild elevation in alanine aminotransferase and aspartate aminotransferase. Almost all these elevations were within normal limits and no patient was clinically symptomatic. No other significant differences were observed between the pravastatin and the placebo-treated groups with regard to other adverse effects and to patient compliance and withdrawal. It is concluded that pravastatin has a beneficial effect on the lipid profile and that the drug is safe and well tolerated.

[Sweet's syndrome in a young woman].

Sweet's syndrome is an uncommon and dramatic skin disease associated with systemic symptoms such as fever, headache and arthralgia. Since it is also accompanied by an increased erythrocyte sedimentation rate and leukocytosis, it may be confused with severe systemic infections and other systemic illnesses. We describe a 30-year-old woman who presented with typical features of the disease. They included high fever, headache, sore throat, increased sedimentation rate, and a painful violaceous, nodular and papular rash on her limbs and upper trunk. Histologic features included dense neutrophilic infiltration and edema of the dermis, with foci of leukocytoclasia, but without leukocytoclastic vasculitis. There was a dramatic repose to treatment with prednisone.

Meth A fibrosarcoma cells express two transforming mutant p53 species.

Expression plasmids directing the synthesis of various forms of the p53 cellular tumor antigen were compared with respect to their biological activities. All plasmids encoding wild type p53, derived from two different cDNA libraries, had absolutely no detectable activity when assayed for transformation of primary rat embryo fibroblasts in collaboration with Ha-ras. In contrast, p53 variants carrying point mutations in the protein coding region exhibited at least some transforming activity. Most notably, this was true for both types of mutant p53 cDNA clones isolated from Meth A cells. The data indicate that these cells, derived from a chemically-induced tumor, carry two independently mutated p53 alleles, each encoding a transformationally activated protein. This may imply that the mutations in the p53 gene played a role in the development of the Meth A tumor. Finally, cells overexpressing a transfected mutant p53 exhibit a physical complex between this exogenous p53 and its endogenous counterpart, possibly resulting in the stabilization of the latter.