Clinical profile, laboratory characteristics and outcome in miliary tuberculosis

We report a retrospective series of 100 non-HIV adult patientswith miliary tuberculosis (MTB) treated in a tertiary care centre.There were 51 males. Their mean age was 35 years. Predisposingconditions existed in 34. Twelve patients had larger-than-miliary(>2mm) shadows in their chest roentgenograms. Five presentedwith acute respiratory failure, and early treatment cured fourof them. Hyponatraemia occurred in 42/60 patients (70%) forwhom values were available. Twelve patients (12%) died of MTB.Temperature     

PLASMA STEROID CONCENTRATIONS IN PATIENTS WITH HYPOPITUITARISM AND KALLMAN''S SYNDROME: EFFECTS OF TESTOSTERONE REPLACEMENT THERAPY

To determine the adrenal contribution to plasma concentrations of steroids potentially derived from both the adrenal and the testes, plasma levels of pregnenolone (Δ⁵P), progesterone (P), dehydroepiandrosterone and its sulphate (DHA and DHAS) and androstenedione (Δ⁴A) were measured in four men with isolated gonadotrophin deficiency and anosmia (Kallman's syndrome). A comparison of these levels with those seen in ten patients with both adrenal and testicular failure (hypopituitarism) and in sixteen normal age-matched men was made. As expected, the basal plasma levels of most steroids were low in patients with hypopituitarism. An exception was the normal Δ⁵P levels in most patients. In the patients with Kallman's syndrome both DHA and Δ⁵P were elevated whereas Δ⁴A and P were low. When expressed as ratios, Δ⁵P/P was increased in both groups. DHA/Δ⁴A was increased in Kallman's syndrome but not in hypopituitarism. Following ACTH infusion, no significant changes in these ratios were observed. To determine whether testosterone deficiency was in part responsible for the abnormal Δ⁵/Δ⁴ ratios, three patients with hypopituitarism and two with Kallman's syndrome were treated for 3 months with intramuscular testosterone. A decrease in the DHA/Δ⁴A ratio was seen in all patients and a decrease in Δ⁵P/P in all but one patient. In most cases these changes were produced by a fall in the Δ⁵ steroids as well as an increase in Δ⁴ steroids. These findings suggest that a defect in the metabolism of Δ⁵ steroids exists in patients with hypopituitarism and Kallman's syndrome. In hypopituitarism the defect involves the metabolism of Δ⁵P to both DHA and P. In Kallman's syndrome only the metabolism of Δ⁵P to P is defective. Testosterone therapy alone or in combination with other appropriate hormonal replacement increases the metabolism of Δ⁵ to Δ⁴ steroids.     

Primary renal inflammatory malignant fibrous histiocytoma: A diagnostic challenge

Renal inflammatory malignant fibrous histiocytoma (MFH) is an extremely rare lesion and is a great masquerader of common benign renal inflammatory lesions, especially xanthogranulomatous pyelonephritis (XGPN). The clinical presentation of mass with fever and peripheral leucocytosis (marked at times), and marked inflammatory, predominantly neutrophilic, infiltrate obscuring the malignant cells on histopathology, can lead to delay in the diagnosis of this poor prognostic malignant tumor. We present the case of a patient who underwent radical nephrectomy with a clinical diagnosis of renal malignancy, but histopathology showing XGPN. The patient showed an initial clinical response, only to recur two times, ultimately leading to a histological and immunohistochemical diagnosis of inflammatory MFH. The diagnosis, histology, therapeutic options and prognosis of this rare lesion are discussed.     

Experimental Renal Erythrocytosis. I. Effects of Pressure and Vascular Interference

Experimental data presented in this study indicate that prolonged pressureexerted on the kidneys of rabbits may lead to true erythrocytosis. With approximately 60 per cent of rabbits developing erythrocytosis, the pressure ofexperimentally induced unilateral hydronephrosis appears to be most effective in this respect. It is suggested that of the role of the renal medulla in theproduction of erythrocytosis is an important one. Interference with renalarteries and veins did not result in erythrocytosis. The role of erythropoietinand the possible mechanisms by which "renal pressure erythrocytosis" is produced is discussed.

Submitted on July 25, 1963 Accepted on February 10, 1964     

Monoclonal Antibody Defined Phenotypes of Peripheral Blood Lymphocytes in Cancer of the Uterine Cervix

ABSTRACT: Immunological phenotypes of lymphocytes from peripheral blood of 100 patients with different stages and histologies of cancer of the uterine cervix were analyzed using monoclonal antibodies and F(ab)₂fragments of antihuman immunoglobulin. The T lymphocyte population was decreased in advanced cases of the cancer along with a rise in the B cell numbers. The OKT4+ cells generally showed a decrease in the cancer patients in contrast to the increase shown by the OKT8+ cells. The OKT4/OKT8 ratio was altered in this cancer except in patients with stages I and IIA. In terms of histology, the poorly differentiated tumors showed a higher imbalance of the cellular composition when compared to the well-differentiated and moderately differentiated tumor-bearing patients. These findings point toward a possible alteration in the immune effector cells of these cancer-bearing patients.     

Similar CD19 Dysregulation in Two Autoantibody-Associated Autoimmune Diseases Suggests a Shared Mechanism of B-Cell Tolerance Loss

: We report here that dysregulation of CD19, a coreceptor that augments B-cell receptor (BCR) signaling, occurs at two B-cell differentiative stages in patients with systemic lupus erythematosus (SLE) and antineutrophil cytoplasmic autoantibody (ANCA) associated small vessel vasculitis (SVV). The na?ve B cells of nearly all SLE and ANCA-SVV patients express approximately 20% less CD19 than healthy control (HC) B cells. In contrast, a subset of memory B cells of some SLE and ANCA-SVV Pts (25-35%) express two to fourfold more CD19 than HC B cells. These CD19(hi) memory B cells are activated and exhibit evidence of antigen selection. Proteome array analysis of 67 autoantigens indicates that CD19(hi) SLE Pts exhibit a distinct autoantibody profile characterized by high levels of antibodies to small nuclear ribonucleoproteins and low levels of antiglomerular autoantibodies. These findings have implications for autoreactive B-cell activation and suggest a shared mechanism of B-cell tolerance loss in these two diseases.     

Narrow QRS Tachycardia with Transition: What Is the Mechanism?

A 50‐year‐old woman underwent radiofrequency catheter ablation of narrow QRS tachycardia that was terminated with intravenous adenosine. Twelve‐lead electrocardiogram was normal during sinus rhythm. The electrophysiological study showed normal atriohisian and hisioventricular intervals during sinus rhythm. Atrial burst pacing reproducibly induced two narrow QRS tachycardias. Figure 1 shows spontaneous switch of tachycardia 1 to tachycardia 2. What are the likely mechanisms of the tachycardia and the transition?