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.

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%).

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 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.

Airway responsiveness of firefighters after smoke exposure.

Ventilatory function and airway reactivity of 20 firefighters were studied one hour before and one hour after exposure in a smoke chamber. None showed an increase in airway reactivity to inhaled histamine before exposure. Eight (80%) of the regular firefighters, however, had an increase in airway reactivity after exposure in the smoke chamber. After six hours, three of the firefighters still had increased airway reactivity. All were non-reactive after 24 hours but the ventilatory function of the three firefighters who were reactive after six hours did not return to baseline values. The duration of service as a firefighter is the major contributing factor to the change in airway reactivity. This increase in airway responsiveness among regular firefighters suggests that some form of chronic epithelial injury is needed before an increase in airway responsiveness is seen.

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.

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.

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.

Pulmonary epithelial permeability in bronchiectasis.

We measured pulmonary epithelial permeability in 17 non-smoking patients with generalized bronchiectasis, of whom six had cystic fibrosis, by determining the half-time clearance from lung to blood (T1/2LB) of inhaled 99mTc-labelled diethylene triamine pentaacetate. Their age range was 15-79 years and the range of their FEV1 measurements was 20-87% of the predicted normal. Sputum obtained by prestudy chest physiotherapy revealed significant colonies of Pseudomonas aeruginosa in six, Haemophilus influenzae in three, Staphylococcus aureus in three and Pasteurella mitocida in one patient, while in the remainder there was normal flora only. Lung clearance was significantly faster in the 13 culture-positive patients (mean T1/2LB = 28 minutes) compared with the four culture-negative patients (mean T1/2LB = 54 minutes). There was no correlation between T1/2LB and prestudy FEV1. The study was repeated in six patients following a course of antibiotics. In two patients only was the sputum cleared of organisms and in those the lung permeability decreased significantly. There was no change in lung permeability in the four patients in whom it was impossible to eradicate the sputum organisms. Thus, in our patients with generalized bronchiectasis, lung permeability was increased only in those with both purulent sputum and significant colonization of the respiratory tract by bacterial pathogens. However, this increase in lung permeability was not associated with worse lung function.

[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.

Histamine receptors and pulmonary epithelial permeability.

In seven normal subjects and five asthmatics we have compared the effects of inhaled histamine with that of betahistine (a relatively selective H1-receptor agonist) and that of impromidine (a relatively H2-receptor agonist) on pulmonary epithelial permeability, as measured by the half-time clearance from lung to blood of inhaled 99mTc-DTPA (t1/2LB). Both histamine and betahistine produced statistically significant falls in baseline t1/2LB and peak expiratory flow rate, while impromidine produced no significant effects on either parameter. Similar results were obtained in normal subjects and asthmatics alike. In four of the normal subjects, histamine-induced falls in t1/2LB and peak expiratory flow rate were prevented by oral pretreatment with terfenadine 120 mg but not by cimetidine 400 mg. Histamine-induced increases in lung permeability and bronchoconstriction are both mediated via H1-receptors in normal and asthmatic subjects.

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.

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.