Human brucellosis is usually caused by one of three species of the genus Brucella: melitensis, abortus, and suis; it is rarely caused by Brucella canis.3 Brucellae are small, non-motile, gram negative capnophilic coccobacilli with optimum growth at temperature of 37°C and a pH of 6-6-6-8. Brucellosis is found primarily in animals and is spread to man by direct contact with infected tissue or by ingestion of infected animal products, most commonly milk or milk products. In Westem countries, brucellosis is an occupational disease found mainly in farmers, people working in meat packing plants, veterinary surgeons, and livestock producers. In other areas of the world the disease is more widespread and is found in the general population.

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SUMMARY A case of left ventricular pseudoaneurysm due to rupture of a myocardial tuberculoma is presented. The diagnosis of pseudoaneurysm was initially suggested by echocardiography and was confirmed by angiocardiography. The aetiology was suggested at operation and confirmed by histological examination. This is a very rare condition which is usually diagnosed only at necropsy. Case reportA 38 year old African hospital employee had a severe, central, crushing chest pain which lasted for four hours. For the next five days he had intermittent pleuropericardial type pain in the left side of the chest. He then sought medical advice. He gave no history of chest pain before this. Five years ago he had had fever associated with patchy bronchopneumonic infiltration of the right lung base; sputum analysis and culture were negative for pathogens. Two months after that he had transient atrial fibrillation which spontaneously reverted to sinus rhythm. A tuberculin skin test had been positive in 1976. The patient had never had treatment for tuberculosis.Physical examination at the time of admission showed a healthy looking adult in no acute distress. Pulse rate was 80 beats per minute and regular, temperature was 37°C, and blood pressure was 140/100 mm Hg. Jugular venous pressure was not raised; there was no cardiac enlargement; first and second heart sounds were normal. There was no pericardial rub. The chest was clear; the liver and spleen were not palpable and there was no oedema in the legs.The electrocardiogram showed changes of an inferior myocardial infarction. An electrocardiogram recorded three years earlier had been normal. The chest x ray film showed a heart of normal size with clear lung fields. Serum concentrations of cardiac enzymes were normal and the erythrocyte sedimentation rate was 35 mm/hour (normal 0-5). communicating with the left ventricular cavity through a narrow necked channel (Fig. 1) (Fig. 2).Four weeks later the patient underwent surgery. The posterior pericardium was found to be thickened and there was a haemorrhagic pericardial effusion. A hole, 1 cm in diameter, was found in the lower left ventricular wall. The hole was patched and the pericardium and pseudoaneurysm were resected and sent for histological examination. The 603 on 10 May 2018 by guest. Protected by copyright.

Endomyocardial fibrosis is a disease of unknown origin which has not previously been described in detail from the Middle East. The clinical, echocardiographic, hemodynamic and angiocardiographic findings in eight patients (five men and three women, mean age 38 years) are presented. Two patients had right-sided involvement, two had left-sided involvement and four had biventricular involvement. The presence of a small ventricle with obliteration of the apex and a large atrium is a two-dimensional echocardiographic finding highly suggestive of endomyocardial fibrosis. Hemodynamic characteristics of dip and plateau on ventricular pressure curves were present in six patients. Ventricular angiography was diagnostic in all cases. Endomyocardial biopsy yielded positive findings in three of six patients and is not essential for diagnosis.