[Tuberculosis of the spine and ribs].

Tuberculosis of the spine or ribs is uncommon, occurring in less than 1% of patients with tuberculosis (TB). 2 women are presented who recently immigrated from Ethiopia and India, respectively. One, aged 55, presented with chest pain, fatigue and several masses under the skin of the scalp. Chest X-ray and CT scan suggested Pancoast tumor, and the lateral parts of the first 2 right ribs were absent. The origin of the patient, clinical findings and positive PPD suggested TB of the ribs and anti-TB therapy resulted in cure. The diagnosis was later confirmed by a positive culture. The other woman, aged 68, presented with fatigue, mild abdominal pain and axillary lymphadenopathy. The PPD was positive and X-ray showed widening of the mediastinum. A caseating granuloma with Langhans epithelioid cells was found in a lymph node. Flaccid paraparesis developed before therapy was started. CT scan showed a typical picture of TB affecting the T3-T6 vertebrae. Drainage of a cold abscess of the spine via the anterior approach was followed by anti-TB therapy. Culture of a biopsied lymph node and of pus obtained at operation confirmed the diagnosis of TB. The patient died 2 months later from gastrointestinal bleeding. Awareness of the unusual presentations of various forms of TB is mandatory in countries with immigration from countries in which TB is still common.

Longitudinal study of magnesium status of Israeli military recruits.

The following study was conducted to assess the biochemical and nutritional status of new military recruits during 12 weeks of strenuous physical activity. Calorie and magnesium (Mg) intake, energy expenditure, and serum, red blood cell (RBC) and mononuclear cell (MNC) Mg were assessed at the start, after 6 weeks and after 12 weeks of training. The results provide evidence that MNC Mg content decreases, whereas serum Mg increases, under prolonged, strenuous training conditions in previously unconditioned military recruits. Mg dietary intake alone could not account for these changes. It is postulated that this decrease in MNC Mg (from 64.76 +/- 34.99 to 23.81 +/- 15.55 fg/cell), unparalleled by similar changes in serum Mg or RBC Mg, reflects a reduction in exchangeable Mg body stores, and the onset of a Mg deficiency state.

Pulmonary alveolar proteinosis associated with recurrence of Hodgkin's disease in the lung.

We report the case of a 36-year-old woman who presented with the clinical and histological features of pulmonary alveolar proteinosis (PAP) 13 years after the diagnosis of Hodgkin's disease. The PAP preceded the recurrence of Hodgkin's disease in the lung by a few weeks. To the best of our knowledge this patient is the first documented case of recurrent Hodgkin's disease in the lung associated with pulmonary alveolar proteinosis.

[Inflammatory cells in bronchial lavage fluid after general anesthesia and artificial respiration].

Bronchial lavage was performed immediately after intubation and artificial respiration (sample A) and one hour later (sample B) in 26 patients who underwent general anesthesia for elective surgery, but were otherwise normal. The number of cells recovered in sample B was significantly greater than that in sample A (5.64 +/- 4.62 x 10(6) vs 1.42 +/- 0.99 x 10(6). This difference was greater in smokers than in nonsmokers. There was also a significantly greater proportion of granulocytes in sample B compared to sample A. The results were similar after inhalation or after intravenous anesthesia. There were dynamic changes in quality as well as quantity of inflammatory cells in the lower respiratory tract following intubation and artificial respiration.

[Decreased bone marrow cellularity and hemosiderin in normal and overtrained runners].

The frequency and significance of decreased bone marrow cellularity (BMC) and bone marrow hemosiderin (BMH), and their possible relations to hemoglobin, iron, iron saturation and serum ferritin levels, were studied in 18 normally trained and 18 overtrained competitive distance runners. Decreased BMC was more pronounced in the overtrained runners: mild to moderate hypocellular marrow was found in 25% of them, and severe hypocellularity in another 25%, as compared to 18% and 3.5%, respectively, in the healthy runners. Increased erythrocyte mean corpuscular volume (greater than 95 mu 3) was found in 24% of the runners, but in only 3.5% of the controls. Decreased BMH was found in both the overtrained (1.3 +/- 2.0 hemosiderin granules per 100 normoblasts) and the controls (1.5 +/- 1.9 granules). There were no significant differences in levels of hemoglobin, mean corpuscular volume and serum iron, iron saturation and ferritin. The decreased BMH in the face of normal hemoglobin and serum iron and ferritin suggests that as a group, competitive distance runners do not suffer from overt iron deficiency but that iron might be stored differently, with a lesser proportion in the bone marrow. The more pronounced decrease in BMH of overtrained distance runners may indicate a possible relationship, and decreased BMC may identify runners who may be becoming overtrained.

[Mammary tuberculosis mimicking breast cancer].

Breast masses in the 7th decade of life should be considered cancerous and immediate diagnosis and treatment are indicated. Mammary tuberculosis is rare, especially in developed countries. It usually results from reactivation of dormant pulmonary and pleural tuberculous foci. We present a 66-year-old woman who was hospitalized for biopsy of a breast mass. 4 years previously there had been trauma to the chest, and several pleurocenteses were required to remove sterile exudate. The past history, recent immigration from an endemic area, physical examination and chest X-ray, suggested tuberculosis. Needle aspiration of the affected breast yielded M. tuberculosis. Specific therapy and corticosteroids resulted in complete cure.

[Endobronchial tuberculosis].

Endobronchial tuberculosis (EBTB) is not rare. It usually affects the upper lobe bronchi. Bronchoscopic examination may reveal white gelatinous material in the bronchial lumen, mucosal ulcerations, polypoid inflammation, scattered green-blue pigmented areas and narrowed bronchi with post-stenotic dilatation, some of which resemble colored dolomite caves. 2 women, aged 70 and 84, are presented, 1 of whom had been suffering for a year from persistent dry cough and the other from diffuse pneumonia resistant to several antibiotics. Fibreoptic bronchoscopy showed the characteristic picture of EBTB, later confirmed by positive cultures. Recognition of the clinical, radiological and bronchoscopic spectrum of EBTB makes it possible to start treatment before bacteriological diagnosis of tuberculosis from endoscopically recovered material.

Decreased Cellularity and Hemosiderin of the Bone Marrow in Healthy and Overtrained Competitive Distance Runners.

In brief: Fourteen healthy and seven overtrained competitive distance runners were studied to investigate the frequency and significance of decreased bone marrow cellularity (BMC) and bone marrow hemosiderin (BMH) and the relationship between BMC, BMH, hemoglobin, and serum ferritin levels. Bone marrow hypocellularity or mild hypocellularity was found in 54% of the healthy male runners. Hypocellular marrow was found in 66% of the overtrained male runners. Absence or severe reduction of BMH granules was found in all runners. The mean hemoglobin and serum ferritin values were normal but somewhat lower than those of a control group. There may be a direct relationship between decreased BMC and years of running.

Cromolyn prevents bronchospastic attacks caused by Bacillus Calmette Geurin immunotherapy for malignant melanoma patient.

Bacillus Calmette Geurin (BCG) skin immunization is an adjuvant therapy for malignant melanoma patients. Adverse reactions to BCG skin immunization therapy are not uncommon and usually present as fever, influenza-like syndrome, pruritus skin rash, ulcers at the injection site, regional lymphadenopathy, and liver dysfunction. To our knowledge, a bronchospastic BCG immunotherapy-related attack has not yet been reported. We present a case of a patient with malignant melanoma who developed an unusual reaction during BCG immunotherapy. He developed asthma-like attacks after treatment, which could be prevented by inhalation of Cromolyn prior to and after therapy.

A computerized tube leukocyte adherence inhibition assay in the diagnosis of human lung cancer.

A computerized tube LAI assay was used to determine the antitumor immune response in lung cancer patients. A standardized assay was established by the use of tumor antigen recovered from the spent medium of lung and colon adenocarcinoma cell lines. Furthermore, modulation of the assay by prostaglandin E2 (PGE2) was used to increase its sensitivity. Of 65 patients with epidermoid lung cancer, 34 (52.3%) had a positive nonadherence index (NAI). The NAI was inversely related to tumor burden, with 31 of 44 (70.6%) patients with lung cancer stages I and II and only 3 of 21 (14%.2%) patients with stage III having positive assays (greater than 30%). Addition of PGE2 to the as say increased the overall sensitivity so that a positive NAI was obtained in 88.6% of patients with lung cancer stages I and II, and 88.6% with stage III, respectively. Of 174 individuals from the control group, positive NAI was found in only 9 and 3.8% of patients with chronic obstructive pulmonary disease and normal controls, respectively. These results support previous observations on the specificity and sensitivity of the LAI assay in the diagnosis and study of human cancer.

Exacerbation of asthmatic symptoms after cessation of nifedipine therapy.

Marked improvement in the respiratory status of two patients with chronic obstructive lung disease was observed during treatment with nifedipine for angina pectoris. Cessation of the drug led to an exacerbation of asthmatic symptoms in both patients which necessitated initiation of bronchodilator therapy. Nifedipine is a known calcium antagonist and as such it has been suggested that it diminishes the transmembrane penetration of calcium ion into bronchial smooth muscle cells and mast cells, thus leading to bronchial muscle relaxation and less mediator release. The complication of increased asthmatic symptoms after cessation of nifedipine therapy has not been previously emphasized and should be taken into account while treating patients with known obstructive airway disease.

Gaucher's disease: unexpected diagnosis in three patients over seventy years old.

Gaucher's disease is usually diagnosed in the first or second decade of life with the appearance of bone pains, splenomegaly and hemorrhagic manifestations due to thrombocytopenia. When the hematological parameters are preserved and the enlarged spleen not evident until late in life, patients are rarely identified as having Gaucher's disease and the diagnosis is based only on the presence of Gaucher's cells in bone marrow. We present here three cases of elderly patients aged 81, 73 and 72 years in whom the disease was a surprise finding of bone marrow examination.

Bone marrow iron depression in competitive distance runners.

Suboptimal hemoglobin and serum iron have been reported in endurance athletes. In the present study peripheral blood, bone marrow cellularity and hemosiderin, serum iron and serum iron binding capacity were observed in 12 competitive distance runners. Hemoglobin, hematocrit, mean corpuscular volume and concentration, serum iron and iron binding capacity were within normal range. Peripheral blood showed mild hypochromia in six runners, bone marrow cellularity was reduced in two, while bone marrow hemosiderin granules were absent in seven and traces were seen in five. These data suggest that a proportion of highly trained distance runners have insufficient iron stores and need supplementation to balance their iron requirements.