Idiopathic lipoid pneumonia in an adult treated with prednisolone.

The treatment of lipoid pneumonia, an uncommon chronic lung condition, is generally conservative. We describe a patient with idiopathic lipoid pneumonia who was successfully treated with oral steroids with improvement of chest radiographic abnormalities.

Rapid shallow breathing (frequency-tidal volume ratio) did not predict extubation outcome.

This was a prospective study of 52 patients that were extubated in our medical intensive care unit. Rapid shallow breathing, represented by a ratio of frequency to tidal volume (f/VT) of more than 105, was evaluated either on continuous positive airway pressure or pressure support prior to extubation as a marker of extubation outcome. Twelve out of 13 patients (92 percent) with rapid shallow breathing (f/VT ratio > 105) were successfully extubated. Out of 9 extubation failures only 1 patient had a f/VT ratio more than 105 (11 percent). A measured f/VT ratio of less than 105 had a sensitivity and specificity of 72 and 11 percent, respectively, for extubation success. Patients who had unsuccessful outcomes were ventilated for a significantly more prolonged period (9.6 +/- 6.8 d vs 4.6 +/- 3.9 d, unpaired t test, p = 0.004). We conclude that the presence of rapid shallow breathing during a weaning trial with the patient on partial ventilatory support does not necessarily preclude successful extubation.

Sudden death from primary lung abscess in middle-aged diabetic men--two case reports.

We describe the course of illness in two middle-aged diabetic men who died suddenly from primary lung abscesses. They were in apparent good health and presented with fever, cough and small lung abscess [less than 5 cm] on chest radiographs. While receiving standard antimicrobial therapy in hospital, they experienced sudden respiratory arrest from aspiration of purulent material presumably following the drainage of lung abscess contents. This is a very unusual complication and the similar clinical features between these two cases prompted this report.

Single-dose and steady-state effects of controlled-release salbutamol on drug level and airflow obstruction in patients with asthma.

Oral medication remains the mainstay of treatment for many asthmatics. We compared the single dose and steady-state effects of twice daily 4 mg and 8 mg controlled-release salbutamol (CRS) on plasma salbutamol and FEV1 in 10 asthmatic patients in a double-blind, double-dummy, cross-over study. On 5 separate days, one week apart, we measured FEV1 and plasma salbutamol hourly for 12 hours after a single dose and, after twice daily doses (4 mg, 8 mg or placebo CRS) for one week. Controlled-release salbutamol showed controlled release properties and dose effect for the two doses. At steady-state, it provided relatively constant plasma levels for 12 hours. Significant and similar bronchodilatation occurred after both 4 mg and 8 mg CRS taken either as a single dose or a steady-state regime.

The efficacy of high dose inhaled budesonide in replacing oral corticosteroid in Asian patients with chronic asthma.

We studied 22 Asian patients with steroid dependent asthma. Using a clinical approach to the addition of high dose inhaled budesonide and tapering of systematic steroid, we were able to substitute 5 to 20 mg prednisolone with 800 micrograms per day of inhaled budesonide in all patients. There was also a greater reduction in nocturnal symptoms and awakenings and a smaller overnight fall in PEFR during treatment with budesonide than with prednisolone. Inhaled budesonide was an effective long term substitute for prednisolone in chronic asthma.

The toxic strept syndrome: two case reports.

We describe two patients with group A beta hemolytic streptococcal septicemia from minor foci in the skin. They developed extreme toxemia, mental obtundation and multi-system organ failure associated with diffuse erythema. They both survived after appropriate antibiotic and intense supportive therapy. These are examples of the "toxic strept syndrome" which is similar to staphylococcal toxic shock.

Prospective study of the aetiology of adult community acquired bacterial pneumonia needing hospitalisation in Singapore.

A prospective survey of 96 consecutive adult patients with community acquired pneumonia requiring hospitalisation was carried out at National University Hospital, Singapore. Causative pathogens were identified in 58% of patients. Mycobacterium tuberculosis was the most common pathogen (21%), followed by Streptococcus pneumoniae (12%), Haemophilus influenzae (5.2%), Mycoplasma pneumoniae (5.2%) and Staphylococcus aureus (4.2%). Gram-negative organisms (apart from Haemophilus influenzae) were found in 10% of pneumonia patients. More than half of the patients had pre-existing illness, the most common was diabetes mellitus (21%).

Pulmonary epithelial permeability in normal individuals and asthmatic patients.

It has been suggested that an increase in lung permeability is the cause for bronchial hyperreactivity in asthma. A method for measuring pulmonary epithelial permeability (PEP) has been developed recently. PEP is estimated by calculating the half-time clearance of inhaled diethylene triamine penta-acetate, labelled with 99m-technetium, with a scintillation counter over the right upper lobe of the lung. Seven normal subjects and 7 patients with stable bronchial asthma had PEP determined. Mean half-time clearance of 99m TC-DTPA in normals and asthmatics were 52.4 minutes and 52.7 minutes respectively. There was no significant difference (p less than 0.5) between these baseline values. Therefore, in patients with stable asthma there is no increase in lung permeability compared with normal subjects.

Acquired factor VIIIC deficiency due to circulating factor VIIIC inhibitors.

The management of patients with Factor VIIIC inhibitor is frequently a therapeutic challenge. Treatment is often individualized. We describe 3 patients, nonhaemophilic adults, with bleeding diatheses caused by a circulating inhibitor to Factor VIIIC. One patient had long standing rheumatoid arthritis. The other two did not have any apparent underlying disease, although one of them had an antecedent antecedent phenylbutazone injection for arthralgias. Prednisolone was prescribed for two patients which resulted in rapid clinical improvement and the eventual normalization of Factor VIIIC activity. The role and rationale of immunosuppressive therapy in Factor VIIIC inhibitor is reviewed.

Spontaneous pneumothorax in medical practice in a general hospital.

Eighty patients with spontaneous pneumothoraces treated in the University Department of Medicine, Singapore General Hospital from January 1981 to March 1983 were reviewed. There were 75 males and 5 females. Their ages ranged from 15 to 92 years. Dyspnea was the chief representing symptom in 59 patients (74%) followed by chest pain in 47 patients (59%). One patient was admitted with loss of consciousness. Pneumothorax with no discernable associated disease was present in 36 patients (45%) whereas 34 (43%) had chronic obstructive airways disease. Of the remaining 10 patients, active pulmonary tuberculosis was present in 5, bronchogenic carcinoma in 2, bronchial asthma in 2 and bronchopneumonia in 1 percent. Pneumothorax occurred equally on both sides. Single episode of pneumothorax was present in 64 patients (80%). Recurrent pneumothoraces were only present in 16 patients (20%). 57 patients (71%) required chest tube insertion while 14 patients (18%) in addition required either medical or surgical pleurodesis. Death occurred in 6 patients (7.5%) mainly in those with chronic obstructive airways disease. In this study the majority of pneumothoraces occurred in patients with either no underlying pulmonary disease or those with chronic obstructive bronchitis and emphysema. A bimodal age presentation was noted, with the younger patients having no underlying respiratory disorders.

The role of the fibreoptic bronchoscope in the diagnosis of bronchial neoplasm.

We report our experience from January 1980 to December 1985 with the fibreoptic bronchoscope in the evaluation of bronchial disease, particularly bronchial neoplasm. Bronchoscopy was performed in 456 patients (329 men, 127 women) and the pathological results were analysed retrospectively. The main indications for bronchoscopy were the radiological findings of a central mass (22%), a peripheral mass (18%), lobar or segmental collapse (14%), unresolved pneumonia (13%), and haemoptysis as a symptom (15%). Abnormal bronchoscopic findings were noted in 167 patients. This was supported by histological examination in 136 patients (81%). In 43 patients (32%) the diagnosis was only made on cytology. The clinical predictive values of common indications were: central mass 0.53, lobar or segmental collapse 0.51, and superior vena cava obstruction 0.36. The fibreoptic bronchoscope is a highly efficient method for diagnosing bronchial malignancy. Bronchial brushing and aspiration should be performed in all cases to maximise the yield.

[Interaction of the anxiolytic agent buspirone with serotonin and other synaptic receptors in the human brain]. / Vzaimodeistvie anksioloticheskogo agenta--buspirona s serotoninovymi i drugimi sinapticheskimi retseptorami mozga cheloveka.

Buspirone and Mj 138-05 (up to 0.1 mM) did not displace specifically bound (3H) tryptamine, (3H) strychnine, (3H) flunitrazepam and (3H) imipramine in human cortical and hippocampal membrane preparations. At the same time both compounds displayed similar to serotonin affinity (IC50 in the range of 2-6 microM) for (125I)-LSD specific binding sites in the human cortex and hippocamp. IC50 of serotonin and buspirone and Mj 138-05 for (3H) LSD (2 nM) specific binding sites in the hippocamp was determined as 0.14 microM, 2.3 microM and 6.1 microM, respectively; and for (3H) serotonin specific binding sites in the hippocamp as 0.005 microM, 3.8 microM and 21 microM, respectively. The affinity for human cortex (3H) LSD binding sites was 10-fold lower in case of serotonin and 4-fold lower in case of buspirone and Mj 138-05 than in the hippocamp. However, the affinity for (3H) serotonin binding sites in the cortex was the same as in the hippocamp in case of serotonin and 12-15-fold lower than in the hippocamp in case of buspirone and Mj 138-05. It is concluded that in human brain buspirone and Mj 138-05 interact with micromolar affinity with 5 HT2 and are capable of binding to a subpopulation of 5 HT1 receptors in the hippocamp.

Effect of an oral H1-receptor antagonist, terfenadine, on antigen-induced asthma.

We have investigated the effect of a specific H1-receptor antagonist, terfenadine, on antigen-induced asthma. In a double-blind, randomized fashion, nine stable asthmatics were given placebo, or terfenadine 60, 120 or 180 mg orally, 12 and 4 hours before challenge. Cumulative bronchial challenge with specific antigen aerosols were delivered from a nebulizer attached to a breath-actuated dosimeter. Response was monitored by specific airway conductance and measurements from partial expiratory flow-volume curves, performed in a body plethysmograph, on line to a computer. Initially the histamine dose-response curves of four subjects were found to be shifted 10-fold to the right by terfenadine 60 mg, given orally. Compared with placebo, terfenadine 60 mg, given orally. Compared with placebo, terfenadine significantly shifted the mean antigen dose-response curves of all measurements to the right. However, this shift was small and not correlated to the dose of terfenadine. There was marked intersubject variation in the effect. Terfenadine produced no side effects. The immediate bronchial response to antigen can be attenuated by an oral H1-receptor antagonist, but the effect is small and, in general, unlikely to be clinically useful.

[Effect of buspirone and diazepam on cGMP level in the rat cerebellum]. / Vliianie buspirona i diazepama na soderzhanie tsGMF v mozzhechke krysy.

Diazepam at a dose of 5 and 10 mg/kg significantly decreases (by 50 and 60%, respectively) cGMP content 30 min following intraperitoneal injection to rats. Buspirone, at a dose of 2.5-25 mg/kg produced a nonsignificant (up to 18%) and at a dose of 50 mg/kg a statistically significant (p less than 0.05) 30% decrease in cerebellum cGMP content. Taking into account the identical anxiolytic effects of diazepam and buspirone, it is suggested that pharmacological effects of buspirone are not linked to the activation of GABA-ergic system.