Pericarditis presenting and treated as an acute anteroseptal myocardial infarction.

Early recognition and treatment of acute myocardial infarctions have been accepted as improving patient mortality. With the popular use of thrombolytic therapy, it is necessary to rule out contraindications and to consider other causes for ST segment elevation. A unique patient experiencing chest pain with marked and localized ST segment elevation in the anteroseptal leads is presented. He was treated with thrombolytic therapy. Subsequent investigations ruled out the diagnosis of myocardial infarction and confirmed the diagnosis of pericarditis. Although the patient's outcome was uncomplicated, physicians are urged to consider the diagnosis of pericarditis before using thrombolytic therapy to avoid life-threatening complications.

Rhomboencephalitis caused by Listeria monocytogenes.

Listerial rhomboencephalitis is a rare, devastating treatable disease. A previously well 72-year-old man presented with a one-week history of fever and headache. Four days before admission he developed right facial numbness and ataxia. Diagnosis and treatment are described, including the relevant clinical, laboratory and radiological findings.

Prolongation of rat kidney allograft survival by nematodes.

Nippostrongylus infection strongly stimulates TH2 activity in vivo. Given the evidence of cross regulation between TH2 and TH1 cells, and the link between TH1 activity and graft rejection, we examined the effects of Nippostrongylus infection on the fate of kidney allografts in rats. Both prior Nippostrongylus infection and prior treatment with a soluble worm product significantly delayed kidney allograft rejection. Control graft rejection occurred at 9.7 +/- 1.2 days whereas grafts in Nippostrongylus- or worm extract-treated recipients lasted 32.7 +/- 11.3 days and 21.5 +/- 4.6 days, respectively. At day 5 posttransplant mononuclear cell infiltration was much reduced in the Nippostrongylus-treated recipients. Flow cytometry of isolated graft-infiltrating leukocytes showed a marked decrease in infiltrating T cells (82.8% reduction) with both CD4+ cells (81.0% reduction) and CD8+ cells (84.6% reduction) being reduced. CD8+ T cells, in particular, made up a much smaller proportion of the graft-infiltrating cells (22% rather than 49%) in the Nippostrongylus-treated animals as compared with untreated controls. Immunohistochemical assay of the graft tissue confirmed the flow cytometric results. Interleukin 4 expression was clearly demonstrated by RT-PCR of the isolated graft-infiltrating leukocytes from the Nippostrongylus-treated recipients but not from the control recipients. These data are consistent with our current hypothesis that Nippostrongylus delays graft rejection by inducing a cross-regulatory suppression of TH1 activity.