Lympho-glandular toxoplasmosis. A diagnosis often missed.

Lymphoglandular toxoplasmosis has a reputation for mimicking several other diseases, especially infectious mononucleosis. Thus, the correct diagnosis often is not discovered until common conditions have been ruled out and the patient has been subjected to excisional lymph node biopsy. The physician who considers toxoplasmosis early and orders appropriate serologic tests can spare the patient unnecessary surgery.

Bronchial endometriosis and bronchiectasis. A possible relationship.

A 60-year-old patient with cyclic hemoptysis for 30 years was found to have bronchiectasis that was not present when hemoptysis began. Thoracic endometriosis and its possible relationship to bronchiectasis are discussed.

Pneumothorax in sarcoidosis.

We have observed four patients with sarcoidosis who developed pneumothorax. In one of the patients who had a thoracotomy, non-caseating granulomata were seen to be extensively involving the pleura. The patient had five episodes of spontaneous pneumothorax involving both lungs before and after surgery. Such episodes were not observed following insititution of corticosteroid therapy. Whether pneumothorax and sarcoidosis are two independent processes occurring in the same individual or whether the pneumothorax is causally related to the sarcoidosis has not been determined. The fact that the sarcoidosis is usually very extensive before pneumothroax develops would suggest the latter. Rupture of emphysematous blebs or necrosis of subpleural sarcoid tubercles have been proposed as the mechanisms of pneumothorax in sarcoidosis.

Survival after asphyxia secondary to gravel aspiration.

A case of extreme asphyxia and acidemia secondary to mechanical obstruction of the tracheobronchial tree with sand and gravel is described. The roentgenographic appearance, clinical course, and management are emphasized. Survival with no neurologic sequelae after such profound physiologic disturbance has not, to our knowledge, previously been described.

Combined topical pulmonary and systemic gentamicin: The question of safety.

Serum levels were measured in 13 subjects who received gentamicin either by inspiratory intermittent positive pressure breathing (IPPB-I) or by tracheal instillation. Only in the latter group were significant serum levels achieved. It is recommended that systemic doses of gentamicin should be reduced and serum levels closely monitored in order to avoid toxicity when the usual 3 to 5 mg/kg of IM or IV gentamicin is conbined with tracheal instillation.