British journal of diseases of the chest最新文献

We have compared the clinical efficacy of high dose terbutaline sulphate (10 mg four times daily) delivered by either a Nebuhaler or jet nebulizer in 13 patients with chronic bronchitis in a 2-week, open, crossover study.

Both treatment regimens improved run-in symptom scores but no significant changes were recorded in peak flow and spirometry. Side-effects were more common with the Nebuhaler and more patients preferred the nebulizer. However, the Nebuhaler is an alternative therapeutic option for delivery of high doses of bronchodilators in patients with chronic bronchitis.

A retrospective radiographic comparison of two regimens, RHE2/RH10 (n=32) and RHZ2/RH10 (n=37), used in the treatment of tuberculous mediastinal lymphadenopathy is reported. The two groups did not differ in age, pretreatment or post-treatment values. The rate of improvement in serial radiographs was compared between the two groups, each patient acting as his own control. There was no difference in the incidence of initial gland enlargement at 1 month, but at 2 months RHZ2/RH10 had less enlargement (0.05>P>0.01). The rate of improvement was faster in the RHZ2/RH10 group from 2–7 months' treatment, being significantly better than RHE2/RH10 at 2 (P=0.003), 5 (0.01>P) and 7 months (0.02>P). Pyrazinamide (25–40 mg/kg) appears to be superior to ethambutol 15 mg/kg for the initial 2 months of treatment of tuberculous mediastinal lymphadenopathy. The findings may be applicable to peripheral tuberculous lymphadenopathy.

Treatment compliance was assessed by testing multiple urine samples for rifampicin in 113 consecutive patients taking a rifampicin containing regimen for tuberculosis. Nineteen (16.8%) patients had at least one negative urine sample after chromatographic analysis and these patients were more likely to be from social classes IV and V, to be Asian, and to have defaulted from at least one clinic appointment without good reason. A questionnaire was completed by 70 of the patients and four (6%) admitted to having omitted at least one treatment weekly; two of these also had at least one negative urine test. Physicians were only partly successful in identifying non-compliers. The relevance of these findings is discussed.

A cellular lesion developed in the bronchial component of a bronchopulmonary anastomosis in a girl of 6 years with primary pulmonary hypertension. Its histological features were consistent with those of a plexiform lesion.

We describe two cases of asthma associated with concomitant thyrotoxicosis where initial improvement followed antithyroid treatment. Relapse of asthma on thyroxine replacement was accompanied by subclinical hyperthyroidism with elevated levels of triiodothyronine. This emphasizes the need to follow up asthmatic patients closely for biochemical relapse following treatment of thyrotoxicosis.

The development of apical pulmonary fibrosis and bullous disease is a rare but well recognized extra-articular manifestation of ankylosing spondylitis (AS) (1–5). The fibro-bullous disease is usually asymptomatic and diagnosed at an incidental radiological examination. When symptoms do develop, they are usually due to superimposed colonization or infection by bacteria, fungi or mycobacteria (1, 3, 4).

Only six cases of non-tuberculous mycobacterial superinfection in AS have been reported (2–5). We report a patient with AS and progressive apical fibrobullous disease in whom Mycobacterium scrofulaceum was repeatedly cultured over a 12-year period.

Pulmonary infection caused by Arachnia propionica in a patient with hairy cell leukaemia is described. The organism is highly sensitive to penicillin but the patient succumbed to his illness despite treatment with penicillin and various other antibiotics. Various types of opportunist infections are common in patients with hairy cell leukaemia but we believe this to be the first report of infection by Arachnia propionica in such a patient.