Tuberculosis meningitis, Abbassia Fever Hospital-Naval Medical Research Unit No. 3-Cairo, Egypt, from 1976 to 1996.

A total of 1,430 patients with the presumptive diagnosis of tuberculous meningitis were admitted to the U.S. Naval Medical Research Unit No. 3/Abbassia Fever Hospital in Cairo, Egypt from January 1976 to January 1996. Diagnosis was confirmed by culture of the mycobacteria from the cerebrospinal fluid CSF of 857 patients and these patients are included in the final analysis. There were 497 males and 360 females. The patients ranged in age from five months to 55 years. The number of patients admitted during the months of March, April, and May were more than double those admitted during October, November, and December. The duration of symptoms prior to admission ranged from seven to 90 days (mean = 29.5 days). Upon admission, 4% of the patients were alert, 34% were drowsy, and 62% were in a coma. Of the 857 patients studied, 490 (57%) died, 256 (30%) recovered completely, and 11 (13%) recovered with sequelae. The mortality and neurologic sequelae were directly related to the stage of disease and duration of symptoms prior to admission. Mortality was significantly lower in patients admitted in stage II and or with short duration of disease compared with those in stage III and or with prolonged duration of symptoms prior to admission. The use of dexamethasone in patients with tuberculous meningitis significantly reduced the ocular complications that occur in these patients and also significantly reduced the fatality rate.

Focal lesions of the spleen in patients with fever of unknown origin: sonographic patterns and diagnosis.

A review of ultrasonic scans performed for 811 patients admitted at the Abbassia Fever Hospital between 1990 through 1996 for investigation of fever undiagnosed for over 3 weeks revealed 28 cases of focal splenic lesions. They included lymphoma in sixteen cases, tuberculosis in six cases, echinococcal cysts in three, abscess in two, and infarction in one. Final diagnosis was obtained by correlating the ultrasonography and clinical findings, together with pathologic, bacteriologic, serologic and angiographic data.

Splenic tuberculosis in patients with fever of unknown origin.

Splenic tuberculosis is uncommon. We report here splenic tuberculosis in 5 patients with fever of over 3 weeks duration. In the 5 patients, abdominal ultrasonography and/or abdominal computed tomography revealed multiple hypoechoic and hypodense splenic lesions. Diagnosis required biopsy of cervical lymph nodes in four cases and splenectomy in one. Despite vigorous antituberculous therapy with isoniazid, rifampin, and ethambutol, the clinical condition of 2 of these patients worsened and splenectomy was done. Histological examination of a tissue specimen of the spleen showed multiple caseating granulomas.

The effect of varying time at -Gz on subsequent +Gz physiological tolerance (push-pull effect).

INTRODUCTION: Previous studies have demonstrated decreased +Gz tolerance when preceded by 0 Gz or -Gz, referred to as the "push-pull effect." The purpose of this experiment was to observe the effect of varying time duration at -Gz on the push-pull effect. METHODS: During single sessions, six subjects (three men, three women) were subjected to five relaxed exposures to +2.25 Gz on the NAMRL Coriolis Acceleration Platform (CAP). The first and last exposures were control runs that were preceded by +1 Gz. Each experimental run was preceded by -2 Gz for 2, 5, or 15 s. Blood pressure (BP) was monitored using the Finapres at the level of the clavicle. Visual light loss was assessed at +2.25 Gz using a light bar. RESULTS: Mean BP was significantly reduced when the +2.25 Gz exposures were preceded by -2 Gz. Following 15 s of -2 Gz, mean BP decreased more and was slower to recover than for 2 and 5 s of -2 Gz. Reported incidents of visual light loss were: 1 following 2 s, 2 following 5 s, and 4 following 15 s at -2 Gz. There were no reports of visual light loss during control runs. CONCLUSION: During relaxed conditions, the push-pull effect is augmented by increasing duration of the preceding -Gz.