British journal of diseases of the chest最新文献

Thirty-eight patients with carcinomatous pleural effusions had pleurocentesis performed with a fine bore silastic catheter sited under ultrasound guidance. Of these, 27 proceeded to pleurodesis. In the latter group there was a recurrence rate of 3.7% (one patient). Overall there was a complication rate of 26.3% (10 patients), only 5.2% (two patients) requiring active treatment. These results compare favourably with other methods of treatment.

Methyldopa (alpha-methyldopa) was given to patients with cor pulmonale secondary to chronic obstructive airways disease (COAD) to determine its effect on pulmonary haemodynamics. Twenty-five patients were randomly allocated to methyldopa (750 mg daily) or placebo. Pulmonary haemodynamics were measured twice, 12 months apart. Conventional therapies were continued unchanged.

The effects of the drug on pulmonary haemodynamics were inconclusive when considered overall, but total pulmonary vascular resistance (TPVR) fell in all patients on active therapy in whom measurements were obtained both at rest and upon exercise. Only one patient in the placebo group achieved this. Over the trial period there was one death in the active but five in the placebo group. Survival was unrelated to abnormalities in pulmonary haemodynamics at the commencement of the trial in this study although the numbers of patients was small. Postural hypotension developed in patients receiving methyldopa and limited the dose that could be administered.

The problems involved in long term trials of vasodilators in hypoxic cor pulmonale are discussed.

Metered dose inhalers are sometimes used in conjunction with Nebuhaler^R, a 750 ml holding chamber, but the permissible delay time between actuating the aerosol into Nebuhaler and commencing inhalation is unknown. We have compared in 10 asthmatic patients the bronchodilator responses following inhalations of terbutaline sulphate from Nebuhaler after delays of 1, 5 and 30 seconds and following placebo inhalation. Terbutaline sulphate was administered as 2 puffs, each of 250 μg, separated by approximately 15 minutes. After each delay time, terbutaline produced increases in forced expiratory volume in one second (FEV₁), peak expiratory flow rate (PEFR) and maximum expiratory flow following exhalation of 75% of the forced vital capacity ($\text{c}\text{V\_.}{}_{\mathrm{max25}}$) significantly greater than those after placebo (P<0.01). Changes in PEFR did not vary significantly among the three delay times, but the increases in FEV₁ and in $\text{c}\text{V\_.}{}_{\mathrm{max25}}$ were significantly reduced with 30 seconds' delay. It is concluded that the delay between actuation into Nebuhaler and commencing inhalation can be extended from 1 second to 5 seconds without significant loss of drug efficacy, and that further extension to 30 seconds causes only a small loss of bronchodilatation: hence the delay time is unlikely to be of major importance in clinical practice.

Three asthmatic children are reported with shortness of breath due to stridor. The stridor was preceded by a deterioration in asthma control necessitating the introduction or increased dosage of a pressurized beclomethasone inhaler. The stridor mimicked asthmatic symptoms and was only differentiated by auscultation directly over the neck and by response to nebulized adrenaline. One child had a laryngeal foreign body which probably gained entry via a pressurized inhaler.

Pulmonary tuberculosis has rarely been recorded in patients with Behçet's syndrome, but to date no report has convincingly demonstrated any possible association between these two diseases. We describe three cases of pulmonary tuberculosis in patients with Behcet's syndrome and discuss the possible underlying mechanisms.

Seventeen patients with Wegener's granuloma (WG), all of whom had renal biopsies taken at presentation, are reviewed. In conjunction with nasal or transbronchial biopsies renal biopsies aided diagnosis and also yielded prognostic information. The detection of antineutrophil cytoplasm antibodies in the serum of patients with WG is a useful supplementary diagnostic tool.