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The cerebral infection begins in the nasal turbinates and paranasal sinuses and spreads from there along infected vessels to the retro-orbital tissues (where it results in proptosis, ophthalmoplegia, and edema of the lids and retina) and then to the adjacent brain, causing hemorrhagic infarction Numerous hyphae are present within the thrombi and vessel wall, often invading the surrounding parenchyma The cerebral form of mucormycosis is usually fatal in short order Rapid correction of hyperglycemia and acidosis and treatment with amphotericin B have resulted in recovery in some patients Coccidioidomycosis, Histoplasmosis, Blastomycosis, and Actinomycosis Coccidioidomycosis is a common infection in the southwestern United States It usually causes only a benign, in uenza-like illness with pulmonary in ltrates that mimic those of nonbacterial pneumonia; but in a few individuals (005 to 02 percent), the disease takes a disseminated form, of which meningitis may be a part.

The feeling of fatigue interferes with mental as well as physical activities; the patient is easily worried, is mentally inactive, is full of complaints, and nds it dif cult to concentrate in attempting to solve a problem or to read a book, or in carrying on a complicated conversation Also, sleep is disturbed, with a tendency to early-morning waking, so that such persons are at their worst in the morning, both in spirit and in energy output Their.

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The pathologic reactions in the meninges and CSF and the clinical features are very much like those of tuberculous meningitis Coccidioides immitis is recovered with dif culty from the CSF but readily from the lungs, lymph nodes, and ulcerating skin lesions Treatment consists of the intravenous administration of amphotericin B coupled with implantation of an Ommaya reservoir into the lateral ventricle, permitting injection of the drug for a period of years Instillation of the drug by repeated lumbar punctures is an alternative albeit cumbersome procedure Even with the most assiduous programs of treatment, only about half the patients with meningeal infections survive A similar type of meningitis may occasionally complicate histoplasmosis, blastomycosis, and actinomycosis These chronic meningitides possess no speci c features except that actinomycosis, like some cases of tuberculosis and nocardiosis, may cause a persistent polymorphonuclear pleocytosis (see page 635).

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The CSF yields an organism in a minority of patients, so that diagnosis depends upon culture from extraneural sites, biopsy of brain abscesses if present, as well as knowledge of the epidemiology of these fungi Patients with chronic meningitis in whom no cause can be discovered should also have their CSF tested for antibodies to Sporothrix schenkii, an uncommon fungus that is dif cult to culture Several even rarer fungi that must be considered in the diagnosis of chronic meningitis are discussed in the article by Swartz Penicillin is the drug of choice in actinomycosis; amphotericin B and supplemental antifungal agents are used in the others Intrathecal amphotericin is administered in patients who relapse..

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Endless repeating decimals Your calculator can give you a glimpse of what an endless repeating decimal, also called a nonterminating repeating decimal, looks like. The calculator program in a personal computer is excellent for this purpose, because it displays a lot of digits.

Expanded intronic CTG repeat in myotonin kinase Expanded intronic CCTG repeat in zinc nger protein Multigene dysregulation at 4q telomore Exonic GCG expansion (alanine) in poly-A binding protein Collagen VI, subunits 1-3

You know why football is so popular Those people running around hitting each other Hell, no. It s because of the huddle. Every time the clock stops, every time the play is over, the huddle forms, and the fan puts himself in the same situation, tries to figure out what he would do. Football is situation, as much as action.

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