Tuberculous encephalopathy. A rare complication of pulmonary tuberculosis

A case of tuberculous encephalopathy, a rare form of neurotuberculosis, is reported in a 16-year-old girl who had pulmonary tuberculosis and extensive cerebral demyelination. The clinical, laboratory and pathological features of this entity are highlighted and the pathogenesis discussed.(Au)

Failure of combined choroquine and high-dose primaquine therapy for Plasmodium vivax malaria acquired in Guyana, South America

The presence of chloroquine-resistant Plasmodium vivax malaria in the New World has been suspected but not confirmed. We report the cases of three patients who acquired vivax malaria in Guyana, South America, and for whom standard chloroquine therapy (25mg/kg) failed despite therapeutic blood levels. The optimal treatment of Chloroquine-resistant P. vivax malaria is unknown, but recent studies suggest that a combination of chloroquine (25 mg/kg) and high-dose primaquine (2.5 mg/kg over 48 hours) is effective therapy. Two of our patients had recurrences of P. vivax malaria 6-8 weeks after receiving directly observed therapy with this combination. These cases confirm the presence of chloroquine-resistant P. vivax in Guyana and emphasize the need for better treatment regimens for chloroquine-resistant and primaquine-resistant P. vivax malaria.(AU)

Emergency bypass without bypass

We present 2 cases of failed coronary angioplasty, with hemodynamic compromise, where emergengy coronary artery bypass. The hypodynamic nature of the stunned myocardium in this circumstance allow this technique to be applied with relative ease to accessible vessels. As a consequence, reduced morbidity and hospital stay can be anticipated.{AU}