Asymptomatic 'normal' subjects may have a respiratory health burden as assessed by the St Georges Respiratory Questionnaire (SGRQ)

Objectives: The Burden of Obstructive Lung Disease study in Trinidad and Tobago identified subjects with obstruction and no symptoms in approximately 5% of the general population over 40 years old. We reviewed data from a previously published study involving asymptomatic subjects to determine respiratory health burden and relation to lung function. Results: Subject characteristics were: 16 (64%) males, Mean (SD) age 64.8 (6.78) years, forced expiratory volume (FEV1) 2.25 (0.77)L, forced vital capacity (FVC) 2.91 (1.02) L, FEV1/FVC 78.1 (8.31)%. Parameters assessed were FEV1 (1.21 to 3.69 L); FVC (1.32 to 4.88 L); FEV1/FVC (65.2 - 94.7%); SGRQ Total Score (0 to 20.8). Three subjects (12%) had a FEV1/FVC ratio of less than 70%. The correlations (rho, p) of total SGRQ scores were FEV1 (-0.62, 0.001), FEV1% (-0.52, 0.008); FVC (-0.69, < 0.001). Conclusion: Asymptomatic normal elderly subjects had significant respiratory health burden as measured by the SGRQ and this was worse in those with a lower FEV1%. This may apply to elderly persons in the general population.

Clustering of cases of mycobacterium fortuitum infection investigated by molecular typing

Organisms of the mycobacterium fortuitum complex are recognised but uncommon causes of pulmonary disease, primary cutaneous disease and a wide spectrum of nosocomial infections. M fortuitum was isolated from 20 patients over a 15 month period, with a apparent clustering of isolates occurring from January to March 1994. The molecular epidemiology of this clustering eas investigated using an arbitrary primer polymerase chain reaction method (AP-PCR). 21 isolates were studied, which yielded 13 distinct profiles. Multiple isolates from a single patient yielded identical profiles. All of seven isolates recovered during the six week period from January to March 1994 shared a common profile which was distinct from all other isolates, suggesting that a single strain was isolated from specimens from all seven patients. The source of this cluster in uncertain. We can find no epidemilogical basis for an episode of cross-infection within the hospital environment, and it is assumed that contamination of the specimens during collection, transport or processing was responsible for the "pseudo-outbreak" of M fortuitum

Chronic obstructive lung disease: a role for theophylline?

Asthma, chronic obstructive bronchitis, and emphysema represent different forms of chronic obstructive pulmonary disease (COPD). Because they have different causes and are based on different pathophysiology, it is reasonable to suspect they may respond differently to treatment. In particular, bronchodilators, such as theophylline, which are purported to act by preventing the spasm of bronchial smooth muscle, should work in asthma but not in chronic bronchitis or emphysema. However, theophylline and other bronchodilators do improve breathing in all three forms of COPD, although to different degrees. Theophylline's effectiveness in chronic bronchitis and emphysema is attributed, in part, to the observation that these forms of COPD commonly have a reversible component (bronchospastic). Furthermore, it is now known that theophylline's mechanism of action includes a strengthening of the diaphragm and other muscles of respiration. These additional mechanisms may explain theophylline's effectiveness in those forms of COPD that lack a bronchospastic component. (AU)

Prevention and treatment of some anaesthetic accidents

An account is given of some of the principles complications of anaesthesia with appropriate prophylaxis, treatment and prognosis. The importance of hypoxia, as a factor in serious accidents, is emphasized (AU)