British journal of diseases of the chest最新文献

The effects of oral treatment with terbutaline sustained-release (SR) tablets (Bricanyl^® Depot) were studied in nine patients who had bronchial asthma and marked diurnal variation in ventilatory function. In a randomized and double-blind study, the patients were treated with terbutaline SR 7.5 mg b.i.d., terbutaline SR 7.5 mg in the morning and 15 mg in the evening and terbutaline SR placebo b.i.d. Each treatment was given for 1 week. The nocturnal decline in the peak expiratory flow rate (PEFR) was 45% during the placebo period, 27% after the lower and 22% after the higher terbutaline SR evening dose (P<0.01 for both treatments compared to placebo). The mean morning PEFR was significantly higher with the high evening dose than with the low evening dose (P<0.01). Mild to moderate side effects were noted. The sustained-release preparation of terbutaline seems to be of clinical value in preventing or relieving nocturnal asthma and early morning dipping. The flexible dose technique, with a higher evening dose, results in further improvements in these patients.

Two Nebuhaler techniques were compared by measuring the response to terbutaline 0.25 mg in 13 asthmatic children. Five breaths each sufficient to operate the Nebuhaler valve resulted in greater bronchodilatation after 10 minutes (P<0.05) than two deep inspirations from residual volume each held for 5 seconds. The peak responses were similar and both methods produced significant bronchodilatation compared with placebo. Either method is satisfactory in children but the former is easier to perform

Nebulization treatment of acute asthma with terbutaline and ipratropium bromide, given either separately with a 30-minute interval or combined as single inhalation, was compared with injection treatment with a combination of terbutaline given subcutaneously and theophylline given intravenously.

Seventy-seven episodes of acute asthma were studied. Nebulization treatment gave the same degree of bronchodilation as the injections, both immediately after treatment [measured as increase in forced expiratory volume in 1 second (FEV₁) in peak expiratory flow rate (PEFR) and improvement of dyspnoea] and during the following 6 days (measured by PEFR recordings at home).

The injection treatment caused a moderate increase in heart rate, whereas no circulatory side-effects were noted during nebulization treatment.

Administration of ipratropium bromide 30 minutes after terbutaline was not more effective than the combination of both substances as a single nebulization.

The relationship between spirometry and daytime blood gases on the one hand and hypoxaemia during sleep on the other was studied in 13 patients with severe thoracic scoliosis. Eight patients had hypoxaemia (mean Sao₂<90%) during sleep. They were characterized by a lower vital capacity (30 versus 50% of predicted, P<0.01) and by a greater fall in vital capacity from sitting to supine (26 versus 7% of sitting VC, P<0.05). All patients with hypoxaemia during sleep were hypercapnic during the daytime. The fall in Sao₂ with sleep was related to the increase in transcutaneous Pco₂, indicating hypoventilation as the main mechanism behind hypoxaemia during sleep in scoliosis patients.

A 32-year-old male intravenous drug abuser was admitted to our institution with constitutional symptoms and sputum smears containing acid-fast bacilli, but no parenchymal disease on chest radiograph. He subsequently developed massive haemoptysis and required an emergency lobectomy. The pathology specimen revealed miliary tuberculosis with extensive caseation, schistosomiasis and cytomegalovirus. This is the first report of massive haemoptysis in the acquired immunodeficiency syndrome. The severe pulmonary haemorrhage was most likely due to miliary tuberculosis.

In this study post-mortem angiograms were prepared from both normal and clubbed hands and attempts were made to estimate the size of the vascular bed in the terminal parts of each finger. Representative cases were also examined histologically. There were no differences between the groups. The increase in blood flow in clubbing is the result of vasodilatation rather than hyperplasia of vessels in the nail bed.