Munchausen syndrome with pulmonary manifestations.

Three patients with Munchausen's syndrome were seen with symptoms suggesting serious pulmonary disease. One patient, a student respiratory therapist, simulated respiratory failure which resulted in a tracheostomy and prolonged ventilator support. The second, a licensed practical nurse, feigned a lupus erythematosis syndrome, with alarming, simulated hemoptysis produced by slashing the posterior tongue with a razor blade. The third patient, a nurse, underwent exhaustive testing at three hospitals for profuse "hemoptysis" until she admitted she obtained the blood from her arm by venesection.

Tuberculosis in Oriental immigrants: a study in military dependents.

Tuberculosis in Oriental immigrants is likely to be resistant to therapy with certain drugs. In 73 military dependents with positive cultures for tuberculosis who immigrated from six Asian countries, the tuberculosis was found to be resistant to isoniazid in 58 percent (42 patients), to streptomycin in 36 percent (26 patients), to p-amino-salicylic acid in 14 percent (ten patients), to rifampin in 7 percent (five patients), and to ethambutol in 7 percent (five patients). Despite the presence of drug-resistant organisms and often extensive disease, negative cultures were attained in all but one patient. Consideration of the high incidence of drug-resistant tuberculosis should be made in planning a program of treatment for these patients. Recognition of cultural differences may also be of value in the successful treatment of this difficult group of patients.

Treatment of pulmonary melioidosis with combination of trimethoprim and sulfamethoxazole.

Treatment with a combination of trimethoprim and sulfamethoxazole proved lifesaving in a patient with pulmonary melioidosis after therapeutic failure occurred with other antibiotics to which the organisms were sensitive in vitro. Antagonistic interaction of drugs occurred when the combination of trimethoprim and sulfamethoxazole was given along with other antibiotics. The combination of trimethoprim and sulfamethoxazole should be considered a major addition to the pharmacologic armamentarium for the treatment of pulmonary melioidosis.

Emphysema-like changes in the lungs of the blotchy mouse.

The Blotchy allele is one of several mutations at the Mottled locus on the mouse X-chromosome. Affected males and heterozygous females within the several allelic groups possess varying degrees of connective tissue abnormalities similar to those found in copper-deficient and lathyritic animals, including aortic aneurysms and reduced skin tensile strength. There is evidence that defective inter- and intramolecular cross-links in collagen and elastin account for these abnormalities. The lung of the Blotchy mouse is also structurally and functionally abnormal. Hemizygous males have larger total lung volumes, markedly increased mean linear intercepts, and diminished internal alveolar surface area when compared to normal control animals. Light microsbopy and scanning electron microscopy show abnormal architecture with enlargement of air spaces and effacement of alveolar septa. Static air and saline pressure-volume curves show that lungs of Blotchy mice have decreased elastic recoil and are significantly more compliant than normal. These abnormalities in the lung of the Blotchy mouse suggest that the defects of the connective tissue proteins described in skin and aorta also involve the lung. The Blotchy strain may be a useful model in which to investigate how abnormalities of connective tissue proteins influence pulmonary structure and function.

Mediastinal histoplasmosis with esophageal abscess. Two case reports.

Two patients were seen with Histoplasma capsulatum infection of mediastinal nodes which had eroded into the esophagus to produce dysphagia. Fungal serologies were of value in the diagnosis in one of the patients. Both patients responded well to amphotericin B therapy. A traction diverticulum was noted to follow healing in 1 patient.