Alveolitis associated with sulphamethoxypyridazine.

A woman developed alveolitis which appeared to be caused by sulphamethoxypyridazine and which resolved after withdrawal of the drug and six months' treatment with prednisolone.

Pharmacokinetic study of the interaction between rifampicin and ketoconazole.

This study assessed the potential pharmacokinetic interaction between rifampicin and ketoconazole, two drugs used to treat the increasingly common combination of Mycobacterium tuberculosis and Candida albicans infection in AIDS patients. The peak plasma rifampicin concentrations in six healthy male subjects were not altered when taken in conjunction with ketoconazole. However, the peak plasma ketoconazole levels were significantly diminished when taken in conjunction with rifampicin, compared to when taken alone (P less than 0.015). The mean area under the curve (AUC) for ketoconazole was significantly diminished when taken with oral or intravenous rifampicin (P less than 0.001).

A comparison of the ventilatory, cardiovascular and metabolic effects of salbutamol, aminophylline and vasoactive intestinal peptide in normal subjects.

Intravenous infusion of placebo for 30 min followed by either salbutamol 10 micrograms min-1, aminophylline 0.2 mg kg-1 min-1 or vasoactive intestinal peptide (VIP) 6 pmol kg-1 min-1 for 30 min was performed in a single blind fashion in six normal volunteers. Both salbutamol and aminophylline increased minute ventilation, (P less than 0.05) the mean increase being 26% and 19% respectively. Aminophylline also increased the ventilatory response to carbon dioxide by 47% (P less than 0.05) when measured by hyperoxic rebreathing, whereas salbutamol and VIP were without significant effect. All three drugs caused a tachycardia, mean increase in the pulse being 16, 8 and 2 beats min-1 for salbutamol, aminophylline and VIP respectively, and aminophylline also increased both systolic and diastolic blood pressure, mean arterial pressure increasing by 14 mmHg. VIP caused haemoconcentration and salbutamol the expected changes in plasma biochemistry. Plasma catecholamines increased slightly during drug infusion, although this effect is unlikely to be important.

Pulmonary Mycobacterium tuberculosis in acquired immune deficiency syndrome.

A case of pulmonary infection with Mycobacterium tuberculosis in a patient with the acquired immune deficiency syndrome (AIDS) was studied. Diagnosis of AIDS was confirmed by the finding of pulmonary M tuberculosis with oral and oesophageal candidiasis accompanied by characteristic immunological changes with evidence of infection with human T cell lymphotropic virus III. Treatment of this patient was complicated by an unusual drug interaction between rifampicin and ketoconazole, leading to subtherapeutic serum concentrations and poor clinical response to treatment. Intravenous treatment was more effective than oral treatment. This drug interaction should be studied in greater detail as ketoconazole and rifampicin may be used together to treat patients with candidiasis and infection with M tuberculosis.

Cerebral aspergilloma in a patient with allergic bronchopulmonary aspergillosis.

The case is described of a woman of 21 who had suffered since childhood from asthma and allergic bronchopulmonary aspergillosis. During her recovery from a period of severe status asthmaticus she developed widespread patchy lung shadowing, signs of an intracerebral space-occupying lesion and high titres of serum precipitins to Aspergillus fumigatus. Post-mortem examination revealed Aspergillus bronchopneumonia and an intracerebral aspergilloma.

Bronchorrhoea.

Bronchorrohea has been defined as a condition in which more than 100 ml of sputum is produced within 24 hours, an amount in excess of that seen in chronic lung diseases. The rheological and chemical characteristics of the sputum are here described. Levels of viscosity, dry weight, N-acetyl neuraminic acid (NANA), fucose, and sulphate fall between those in saliva and mucoid sputum from chronic lung diseases. These levels were always higher in bronchorrhoea sputum than in saliva and therefore may be used in the differential diagnosis of bronchorrhoea and hypersalivation. Bronchorrhoea sputum has the constituents of a bronchial secretion but is low in acid glycoprotein. Certain other features are commonly found - a large amount of froth, increase in viscosity with time, and separation into two phases. Some cases respond to steroids, particularly when the levels of NANA in the sputum are low.

Effect of atropine on sputum production.

The effect of atropine on sputum production has been studied in patients with asthama, chronic bronchitis, and bronchiectasis in some of whom there was bronchorrhoea. In three patients a reduction in sputum volume was observed after atropine but it would seem that the decrease was mainly due to the inhibitory effect on salivary secretion which facilitates spitting. The one patient treated with long-term oral atropine showed a marked reduction in sputum volume although chemical constituents and viscosity levels remained unchanged, suggesting that in this case atropine had an inhibitory effect on bronchial gland secretion.