Double-blind randomized cross-over trial of nocturnal elixir theophylline supplementation of a twice-daily sustained-release theophylline tablet formulation in asthmatic patients.

Sixteen asthmatic patients with normal diurnal activity between 05:00 and 23:00 h participated in this randomized, multiple-dose, double-blind, placebo-controlled, crossover study of the pharmacokinetics and efficacy of evening supplementation of a 12-hourly sustained-release theophylline (SRT) regimen with a nonsustained-release theophylline (NSRT) formulation. The treatments were Nuelin SA (SRT) every 12 h plus, in the evening, either placebo or an additional dose of Nuelin liquid (NSRT), determined to raise the early morning (0300) plasma theophylline concentration (PTC) to 18 micrograms/ml by using the dose-concentration prediction equation established in a study conducted on healthy volunteers and reported in this journal. The 11-day trial included two 24-h inpatient periods during which PTCs and lung functions (PEF, FEV1, FEF25-75, and FVC) were determined every 2 h. The value of the prediction equation was confirmed when the early morning PTC, after evening supplementation with Nuelin Liquid, was raised nearly to the targeted 18 micrograms/ml. The nocturnal peak-to-trough fluctuation in PTC was larger during additional treatment with Nuelin liquid, but the nocturnal peak-to-trough fluctuation in lung function parameters decreased. Overall, airflow during the early morning hours (0100-0500) significantly improved during this chronotherapeutically optimized treatment of adding an NSRT product to the evening dose of a 12-hourly SRT regimen.

[The sick cilia syndrome]. / Siek-siliasindroom.

The incidence of bronchiectasis should decrease because of improved immunization, but certain defects would still cause the malady. Fifteen consecutive patients with bronchiectasis were examined for ciliary defects by examining the nasal mucosae with an electron microscope and measuring the clearance of technetium-99m from the lung with a gamma camera. Three patients were found to have defects. Compound cilia, disorganization of the tubular structure, vacuolization and deficient inner dynein arms were observed. In one patient a loss of cell membranes which returned to normal after 4 months, was observed. Ciliary abnormalitites can either be anatomical or physiological and 'sick cilia' should be considered as a cause of bronchiectasis.

[Universal coaxial anesthetic system]. / 'n Verwisselbare koaksiale narkosesisteem.

A true universal co-axial anaesthetic system has been designed. This system may be used either as a Mapleson A circuit during spontaneous ventilation or as a Mapleson D circuit during controlled ventilation. Conversion to either system may be conveniently carried out by interchanging the pop-off valve and fresh gas inlet, without disconnecting the system from the patient. Resistance to flow of both tubes has been measured and was found to be within acceptable limits. The efficiency of this system in a Mapleson A arrangement was compared with that of a conventional Magill circuit during spontaneous breathing in 2 conscious volunteers. It was shown that no significant difference exists between these systems eith regard to rebreathing, and that the universal co-axial system may be used as efficiently and economically as the Magill circuit during spontaneous ventilation. The co-axial system can be easily connected to a circle system, combining the advantages of the two systems.