British journal of diseases of the chest最新文献

The effect of pretreatment with nifedipine 20 mg sublingually on the bronchoconstrictor response to inhaled histamine and methacholine in asthmatic and normal subjects has been studied. For each agonist the provocation concentration required to produce a 15% fall in FEV₁ (PC15) and a 35% fall in specific conductance (PC35) was determined. In the group of asthmatic subjects the responses to histamine were significantly attenuated by histamine, PC15 increasing from 0.29 mg/ml to 0.68 mg/ml (P<0.001) and PC35 increasing from 0.25 mg/ml to 0.58 mg/ml (P<0.001). Responses to methacholine showed less modification by nifedipine. PC15 increased from 0.23 mg/ml to 0.32 mg/ml (P<0.05). Changes in PC35 were not significant. In the group of normal subjects no attenuation of the response to methacholine was produced by nifedipine but significant increases of PC15 (P<0.002) and PC35 (P<0.005) were produced by the agent. The results are consistent with nifedipine exerting an effect principally on mediators dependent on external calcium sources for stimulus-contraction coupling in the airways. The magnitude of change in the histamine response of the two groups was similar, suggesting calcium dependent mechanisms are not involved in asthmatic hyper-responsiveness.

Haemangiopericytoma, a rare mesenchymal tumour infrequently found within the thorax, is described in a patient who presented with a pleural mass following a lower respiratory tract infection. Specific radiological features leading to a diagnosis have previously been suggested; however, these are challenged in view of the findings in this case. Haemangiopericytoma ought to be considered in the differential diagnosis of an asymptomatic enlarging pleuropulmonary soft tissue mass.

Seventy-three patients with superficial lymph node tuberculosis, who received either 9 months' or 18 months' treatment with rifampicin and isoniazid, supplemented by ethambutol for the first 8 weeks, were followed up for 5 years. No clinical nor microbiological relapse was recorded. The cosmetic results were good in both groups. Initial surgery or aspiration conferred no advantage or disadvantage. The 9-month regimen can therefore be recommended as effective therapy for superficial lymph node tuberculosis.

We measured pulmonary epithelial premeability in 17 non-smoking patients with generalized bronchiectasis, of whom six had cystic fibrosis, by determining the half-time clearance from lung to blood ($\text{T}{}_{\mathrm{<mtext>1</mtext><mtext>2</mtext><mtext>LB</mtext>}}$) 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 Psuedomonas aeruginosa in six, Haemophilus influenzae in three, Staphylococcus aureus in three and Pasteurella mitocida in one patient, while in the remainder there was normal floral only. Lung clearance was significantly faster in the 13 culture-positive patients (mean $\text{T}{}_{\mathrm{<mtext>1</mtext><mtext>2</mtext><mtext>LB</mtext>}}\text{=28}$ minutes) compared with the four culutre-negative patients (mean $\text{T}{}_{\mathrm{<mtext>1</mtext><mtext>2</mtext><mtext>LB</mtext>}}\text{=54}$ minutes). There was no correlation between $\text{T}{}_{\mathrm{<mtext>1</mtext><mtext>2</mtext><mtext>LB</mtext>}}$ 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.

Two cases of empyema with nephrotic syndrome are described, a previously unreported association. In one case the nephrotic syndrome resolved with treatment of the empyema. Renal biopsy in both patients showed mesangiocapillary glomerulonephritis and in one case there was evidence of activation of the alternative complement pathway, which is often associated with this histological type of glomerulonephritis.

The association between glomerulonephritis and empyema is important because it represents a potentially reversible form of renal disease.

We have conducted a survey of all asthmatic patients seen at the Leicester Royal Infirmary Accident and Emergency Department during a 1-year period. A significantly greater number of patients were seen on Sundays and bank holidays. Wheeze was recorded in only 43% of the patients and there was no record of any nocturnal asthmatic symptoms. Peak expiratory flow rate was only recorded in 26% of patients before treatment with nebulized salbutamol (the commonest treatment). Pulse rate, respiratory rate, time of day or month did not determine whether or not a patient was admitted. We conclude that the education of junior doctors in the management of asthma is still deficient.

We reviewed the records of all patients over the age of 80 years undergoing fibreoptic bronchoscopy in St James's Hospital between May 1982 and May 1986, to assess the safety and clinical usefulness of the procedure in this group of patients. Sixty bronchoscopies were performed in this time, 21 patients had histologically proven bronchogenic carcinoma, one had tuberculosis, and one a benign polyp. There was no mortality and no serious morbidity. We concluded that fibreoptic bronchoscopy is a safe, useful procedure which was helping in planning future management in this group of patients.

Four patients are described in whom recurrent large pleural effusions developed secondary to asymptomatic pancreatic disease. The diagnosis was made by measuring the amylase content of the pleural fluid. Endoscopic retrograde cholangiopancreatography (ERCP) and computed tomography (CT) were useful in demonstrating pancreaticopleural fistulae. Two patients underwent laparotomy and distal pancreatectomy. One recovered spontaneously after ERCP appeared to relieve an obstruction of the pancreatic duct and the other recovered after a period of parenteral nutrition. We suggest that pleural fluid amylase content should be measured in any case of exudative pleural effusion of unknown aetiology.