This article presents the range of manifestations of tuberculosis (TB) of the craniospinal axis. Central nervous system (CNS) infection with Mycobacterium tuberculosis occurs either in a diffuse form as basal exudative leptomeningitis or in a localized form as tuberculoma, abscess, or cerebritis. In addition to an extensive review of computed tomography and magnetic resonance features, the pathogenesis and the relevant clinical setting are discussed. Modern imaging is a cornerstone in the early diagnosis of CNS tuberculosis and may prevent unnecessary morbidity and mortality. Contrast-enhanced MR imaging is generally considered as the modality of choice in the detection and assessment of CNS tuberculosis.

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Q Qu ua al li it ty y o of f l li if fe e i in n p pa at ti ie en nt ts s w wi it th h c ch hr ro on ni ic c o ob bs st tr ru uc ct ti iv ve e p pu ul lm mo on na ar ry y d di is se ea as se e i im mp pr ro ov ve es s a af ft te er r r re eh ha ab bi il li it ta at ti io on n a at t h ho om me e P.J. Wijkstra*, R. Van Altena*, J. Kraan* We studied 43 patients with severe airflow obstruction: forced expiratory volume in one second (FEV 1 ) 1.3±0.4 l (mean±SD), FEV 1 /inspiratory vital capacity (IVC) 37±7.9%. After stratification, 28 patients were randomly allocated in a home rehabilitation programme for 12 weeks. Fifteen patients in a control group received no rehabilitation. The rehabilitation group received physiotherapy by the local physiotherapist, and supervision by a nurse and a general practitioner. Quality of life was assessed by the four dimensions of the Chronic Respiratory Questionnaire (CRQ).We found a highly significant improvement in the rehabilitation group compared to the control group for the dimensions dyspnoea, emotion, and mastery. Lung function showed no changes in the rehabilitation group. The exercise tolerance improved significantly in the rehabilitation group compared to the control group. The improvement in quality of life was not correlated with the improvement in exercise tolerance.Rehabilitation of COPD patients at home may improve quality of life; this improvement is not correlated with an improvement in lung function and exercise tolerance.

Background -Several studies have shown that both objective and subjective measurements are related to exercise capacity in patients with chronic obstructive pulmonary disease (COPD) (Thorax 1994;49:468-472) Patients with chronic obstructive pulmonary disease (COPD) usually have a decreased exercise tolerance and a reduced quality of life. While spirometric measurements seem to be related to maximum ventilation in a bicycle ergometer performance,' in general they correlate weakly with less stressful tests such as the walking distance.2 5 Moreover, it has been shown that the transfer factor for carbon monoxide (TLCO) is positively correlated with the walking distance test.67Although dynamic and static lung volumes, compliance, and gas transfer (lung function) generally establish the level of impairment in COPD, Mahler and coworkers showed that maximal inspiratory pressure (MIP) provides additional information on impairment.8 Loiseau and coworkers9 also showed that exercise capacity in patients with COPD was related to the impairment of the inspiratory muscles. In addition, it has been shown in other studies that walking distance tests are related to psychosocial measurements, while no relation has been found between psychosocial measurements and bicycle ergometer tests.4 10 11Both objective and subjective measurements are related to exercise capacity in patients with COPD. However, we are not aware of any research on their relative effect on a walking distance test compared with a bicycle ergometer test. In this study we have therefore investigated the relative contribution of lung function, maximal inspiratory pressure, dyspnoea, and quality of life to the performance in a walking distance test as well as a bicycle ergometer test in patients with COPD. Methods PATIENTSForty patients with known COPD"2 (table 1) who started a rehabilitation programme were studied. Entry criteria were: (a) postbronchodilator FEV, (forced expiratory volume in one second) <60% predicted, and (2) postbronchodilator FEV,/IVC (inspiratory vital capacity) <50% (after two inhalations of 40,ug Rehabilitation Centre,

Clinical experience on meropenem-clavulanate to treat tuberculosis (TB) is anecdotal (according to case reports on 10 patients). The aim of our case-control study was to evaluate the contribution of meropenem-clavulanate when added to linezolid-containing regimens in terms of efficacy and safety/tolerability in treating multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB cases after 3 months of second-line treatment.37 cases with MDR-/XDR-TB were prescribed meropenem-clavulanate (3 g daily dose) in addition to a linezolid-containing regimen (dosage range 300-1200 mg?day -1 ), designed according to international guidelines, which was prescribed to 61 controls. The clinical severity of cases was worse than that of controls (drug susceptibility profile, proportion of sputum-smear positive and of re-treatment cases). The group of cases yielded a higher proportion of sputum-smear converters (28 (87.5%) out of 32 versus nine (56.3%) out of 16; p50.02) and culture converters (31 (83.8%) out of 37 versus 15 (62.5%) out of 24; p50.06). Excluding XDR-TB patients (11 (11.2%) out of 98), cases scored a significantly higher proportion of culture converters than controls (p50.03). One case had to withdraw from meropenemclavulanate due to increased transaminase levels.The results of our study provide: 1) preliminary evidence on effectiveness and safety/tolerability of meropenem-clavulanate; 2) reference to design further trials; and 3) a guide to clinicians for its rationale use within salvage/compassionate regimens.