Severe Chlamydia trachomatis pneumonia in a patient with no immune deficiency.

A 40-year-old patient with no immune deficiency was admitted because of severe bilateral pneumonia and pleural effusion. The diagnosis of Chlamydia trachomatis pneumonia was confirmed by isolation of the pathogen and the appearance of serum antibodies to Chlamydia species.

Coexistence of sporadic multiple endocrine neoplasia and scapular ectopic breast. Coincidence or biologically associated?

We describe a patient who presented with sporadic pheochromocytoma and parathyroid adenoma in the absence of medullary thyroid carcinoma, which coexisted with fully developed scapular ectopic breast tissue. If not coincidental, this association might support the concept that all components of multiple endocrine neoplasia type IIA originate from embryonic ectodermal tissue, and that sporadic multiple endocrine neoplasia type IIA, as well as ectopic breast tissue, may result from a noxious event at a critical embryonic stage.

Biopsy proven evolution of post streptococcal glomerulonephritis to rapidly progressive glomerulonephritis of a post infectious type.

A 15 year old boy with chronic impetigo was admitted with severe acute oliguric renal failure requiring temporary dialytic treatment. Renal biopsy revealed typical diffuse and proliferative glomerulonephritis of the poststreptococcal type. Subsequently high temperature developed with flank pains at the biopsy site, concomitantly with deterioration of renal function. On exploration, a sterile perirenal hematoma was found and a wedge renal biopsy revealed crescentic rapidly progressive glomerulonephritis of the post infectious type. Deterioration to end stage renal failure occurred within a few months. Although universally accepted, biopsy proven evolution from diffuse proliferative and exudative glomerulonephritis to crescentic form of post streptococcal glomerulonephritis has been rarely reported.

Hepatitis in a family infected by Chlamydia psittaci.

Hepatic involvement is considered a rare complication of psittacosis. Occurrence of icteric hepatitis as the cardinal manifestation of the disease has been rarely reported. We describe two members of a family infected by psittacosis, in whom icteric hepatitis was the prominent expression of the disease. The diagnosis of psittacosis was confirmed by isolation of the pathogen and by detection of serum antibodies to Chlamydia species. No serological evidence for acute TWAR infection was found. Chlamydia psittaci was also isolated from the family's parrot.

Gas-liquid chromatographic determination of 3,6-dichloropicolinic acid in soils.

A gas-liquid chromatographic (GLC) method has been developed for the determination of the experimental herbicide 3,6-dichloropicolinic acid (Dowco 290) in soils. The method involves extraction of 1 g soil samples with 1N NaCl at approximately pH 7, methylation with diazomethane utilizing a microgenerator, and detection by electron capture GLC. Interferences are small, so that a cleanup step is not necessary even at the 6 ppb level. The procedure is rapid, requiring only 45 min/sample. Recoveries range from 84 to 94% at the 6-1000 ppb level with a minimum detectable limit of 6 ppb. Standard deviations for the percentage recovery values vary from 10.9 to 2.3 for the tested range of 6.7-670 ppb, respectively.

Acute intoxication with ajmaline.

A 57-year-old man ingested 1,000 mg of ajmaline with suicidal intent. He was unconscious, hypotensive and showed serious disturbances in cardiac conduction on admission. High serum and urine levels of ajmaline were found. Although only 4% of the ingested dose was excreted following forced diuresis, all evidence of toxicity disappeared within 21 h.

Regression of malignant thymoma with metastases after treatment with adrenocortical steroids.

A patient with a malignant lymphoepithelial thymoma and pleural metastases is described. Incidental treatment with adrenocortical steroids after an allergic reaction resulted in a marked regression of the masses for a period of 18 months. A second course of treatment resulted in complete radiological regession of the tumors, and the patient has remained symptom free with normal chestX-rays for a further period of 18 months.

Symptomatic renal artery stenosis superimposed on chronic glomerulonephritis.

We present two patients with proved chronic glomerulonephritis who had severe refractory hypertension and chronic renal failure. In both patients normal-sized kidneys were demonstrated in addition to vascular bruits and Grade III hypertensive retinopathy. These findings raised the suspicion of an etiological condition other than chronic glomerulonephritis underlying the hypertension and renal failure. Renal angiography revealed bilateral severe renal artery stenosis. In both cases renal revascularization was followed by a drop in blood pressure to normal or near normal levels. In selected cases with severe hypertension and chronic renal failure, renal artery stenosis should be considered, despite the coexistence of chronic glomerulonephritis.

Should acute gold overdose be invariably treated?

Acute gold overload is rare and its clinical and pathophysiological consequences are not well delineated. Consequently the therapeutic approach has not been formulated. We describe 2 patients with rheumatoid arthritis in whom an acute gold overload was inadvertently administered. Their subsequent course, without specific treatment, was benign and uneventful. We suggest that with similar cases a conservative approach of watchful expectancy be adopted.

An esoteric occupational hazard for lead poisoning.

A case of life threatening lead poisoning was diagnosed clinically in a Jewish scribe and verified by appropriate laboratory studies. The special ink used by the scribe was found to contain lead in appreciable amounts. Eleven more asymptomatic subjects, both scribes and manufacturers of the ink, were studied and five were found to have subclinical lead overload. Handling or production of this ink is a potential hazard for lead intoxication.

Congenital afibrinogenemia: an unusual case.

We describe a congenitally afibrinogenemic young man who experienced massive spontaneous bleeding episodes at unusual sites, including the thigh muscles, lung and brain. Each of these life-threatening episodes raised theoretical and critical practical problems. A large local hematoma was responsible for an accelerated consumption of fibrinogen, which was relieved following evacuation. It is unusual for an afibrinogenemic patient to survive a number of potentially lethal bleeding episodes.

Haemoptysis as the sole presenting symptom of dissection of the aorta.

A 75 year old man who had had haemoptysis for 24 hours was found to have his left lower lobe compressed by a dissection of the aorta, which was otherwise symptomless.

Levamisole circumvents inhibition of lymphocyte activation imposed by uremic serum.

Uremic serum inhibits thymidine incorporation of phytohemagglutinin-stimulated lymphocytes originating in normal individuals. In this study the effect of levamisole on such inhibition was investigated. Preincubation with a wide range of levamisole concentrations resulted in complete prevention of the inhibitory effect imposed by uremic serum on thymidine incorporation. We would like to suggest that uremic serum possibly inhibits thymidine incorporation of normal lymphocytes by imposing an abnormal cyclic GMP/cyclic AMP intracellular ratio, and that levamisole may restore this ratio to normal.

Pneumaturia: need for diagnostic alertness.

Pneumaturia, an air-filled urinary bladder with or without passage of gas in the urine, is a rare phenomenon in the general population, but is more frequent in defined high-risk subgroups. Relevant symptomatology may be hardly noticeable for a relatively long period; however, the outcome may be serious and sometimes fatal. We present three such cases and discuss diagnostic and therapeutic aspects.