[Hidden diseases: tuberculosis in a woman with a severe mental illness]. / Tbc bij een vrouw met een ernstige psychiatrische aandoening.

Patients with severe mental illness often have only limited access to health care for physical symptoms. They have difficulty in organising their thoughts and articulating their requests for medical help; in addition, they often have a reduced perception of stimuli like physical pain. There may also be a language barrier and sometimes a cultural barrier. The case that we present demonstrates that these are not separate causes but they are interrelated in a complex manner. Screening for a latent disease such as tuberculosis reduces the risk of a delayed diagnosis stemming from the patient's inability to articulate a request for medical help. The physical symptoms of patients with severe mental illness can only be reliably interpreted when there is close cooperation between physicians and psychiatrists.

Postpneumonectomy pulmonary oedema.

The occurrence of pulmonary oedema was studied retrospectively in 243 patients who underwent pneumonectomy in one hospital from 1975 to 1984. Pulmonary oedema developed in eight of 113 patients who had a right sided pneumonectomy and in three of 130 patients undergoing a left sided procedure. It occurred more commonly in patients requiring a second thoracotomy because of blood loss (in three out of seven patients). There were no significant differences preoperatively in pulmonary function, lung perfusion scans, or cardiovascular condition between patients who subsequently developed pulmonary oedema and those who did not. Postoperative fluid balance was significantly more positive in patients developing pulmonary oedema than in those not developing oedema. Thus pulmonary oedema was associated with right sided pneumonectomy, repeat thoracotomy, and more positive fluid balance.

Diagnostic value of bronchoalveolar lavage in ocular sarcoidosis.

Bronchoalveolar lavage (BAL) is an investigation which has already proven its value in the diagnosis and follow-up of patients with pulmonary sarcoidosis. It also appears to be a valuable contribution to the diagnosis of patients presenting with ocular sarcoidosis. We evaluated the findings in BAL in 16 cases with suspected ocular sarcoidosis (14 cases of uveitis, one with eyelid-swelling and one with an inflammatory process of the lacrimal gland). BAL was positive in 11 cases e.g. showed a lymphocytosis with predominantly T4+ helper lymphocytes. There was one patient with ocular signs very suspect for sarcoidosis (a perivasculitis with candle wax infiltrates) with a normal percentage T lymphocytes (2%) in BAL. In two cases BAL was positive and showed a subclinical alveolitis, whereas no changes were seen on the chest X-ray and in Angiotensin Converting Enzyme (ACE) level.

Sarcoidosis with maxillary involvement.

A case of sarcoidosis with maxillary involvement is presented. The patient complained of loose teeth in the upper anterior region, while radiographs revealed a poorly defined radiolucent area round the midline of the anterior maxilla. The diagnosis was verified by histopathologic examination.

Histamine log(dose)-response curves in asthmatics. A comparison between the Wiesbadener Doppelinhalator and the De Vilbiss Model 645 nebulizer.

In 9 asthmatic patients log(dose)-response curves were obtained on 4 successive days with the Wiesbadener Doppelinhalator (WDI) and the De Vilbiss (De V) 645 nebulizer, respectively. log(dose)-response was expressed as a quadratic regression equation. From those equations the dose, causing a fall in response (FEV1) of 10% of the initial value, was obtained and defined as the provocative concentration (PC(10] or sensitivity. Moreover, the reactivity was defined as the slope of the linear regression through the steeper part of the curve. Although we compared the De V and the WDI log(dose)-response curves after correction for the different liquid output, a significantly greater sensitivity was found for the De V nebulizer. As to the reactivity, no significant differences were found. The difference in sensitivity could perhaps be explained by the fact that, as compared with the De V nebulizer, the WDI may cause a larger deposition of aerosol on the throat and the pharynx, due to the much greater linear velocity of its aerosol jet.

Comparison of the bronchodilatory action and side-effects of ipratropium bromide and thiazinamium methyl sulphate: a long-term, double-blind, crossover trial in patients with chronic bronchitis.

A long-term, double-blind study was carried out in 12 male chronic bronchitics with partially reversible airways obstruction to compare the bronchodilatory effects of ipratropium bromide and thiazinamium methyl sulphate and their influence on micturition and visual accommodation. Patients received either ipratropium bromide (160 micrograms daily) by aerosol plus placebo tablets or thiazinamium methyl sulphate tablets (900 mg daily) plus placebo aerosol for 10 weeks. After a 1-week treatment-free period, patients were crossed over to the alternative medication for a further 10 weeks. Measurements were made before and 1 and 10 weeks after the beginning of each treatment period. The bronchodilatory responses were measured by spirometry (VC and FEV1) and maximal expiratory flow volume (MEFV) curves (FVC, PEF, MEF50 and MEF25). Micturition was estimated from a mictiogram, obtained with a system based on an ultrasonic principle. Subjective clinical findings, heart rate and blood pressure were also obtained. The variables from both the spirometric and MEFV measurements showed the bronchodilatory effect of ipratropium bromide to be superior to that of thiazinamium methyl sulphate. Because the largest differences were found in the variables from the effort-dependent, first part of the forced expiration (PEF and FEV1), the results suggest a difference in effect occurring mainly in central and higher airways. Only the MEF25 value after 10-weeks' treatment was lower in the ipratropium bromide period with respect to the thiazinamium methyl sulphate period, but not significantly so. Although 3 patients on thiazinamium had visual complaints no objective disturbances of micturition or accommodation were established.