Pulmonary involvement in idiopathic hypereosinophilic syndrome.

A case of idiopathic hypereosinophilic syndrome (HES) is presented. The patient had been symptomatic and had documented peripheral blood eosinophilia for 9 years. The patients having only pulmonary involvement, seem to have a good prognosis and hence must be considered as a separate subgroup of HES.

Jaundice due to anti-tuberculous drugs--a dose related phenomenon.

Data of 429 cases proved to have tuberculosis and on anti-tuberculous short course chemotherapy was analysed to find the incidence of jaundice due to anti-tuberculous drugs. The group included 257 males and 172 females (M : F ratio of 3 : 2), aged 7 to 75 years. 336 patients received short course chemotherapy for a duration of 6 months, while 93 patients were cases of relapse and hence received treatment for 9 months duration. Of these, 7 patients developed drug induced jaundice; 2 each in the age group of 21 to 35 years, and 36 to 50 years while 3 patients were in the age group of 51-65 years. All of these patients developed jaundice within 2 months of treatment and 6 of these 7 patients were receiving drugs in doses which were not adjusted as per the weight of the patient. None of these 6 patients redeveloped jaundice when the drugs were started in doses adjusted accurately as per the weight of the patients, in accordance with IUAT recommendations. One patient (0.21%), who was staredon weight adjusted dosage of anti-TB drugs developed jaundice which was probably due to isoniazed hypersensitivity.

Assessment of exercise tolerance in chronic bronchitis and interstitial lung disease.

Cardiopulmonary exercise testing has a definitive place in objective evaluation of the subjective sensation of breathlessness. In the present study 21 patients with COPD, 10 with ILD and 17 normals were subjected to stage 1 exercise testing and correlations were sought between Vo2 and work, FVC, FeV1, Ve, respiratory rate and tidal volume and between VCO2 and work. In COPD and ILD the Vo2 correlated with work, Fev1, Fvc and Ve whereas in normals it correlated with the VE but not with the FeV1 and FVC. In COPD VO2 correlated with TV though this was not the case in ILD. Thus stage 1 exercise testing can be a useful additional method to assess the disability in COPD and ILD although differentiation between these two respiratory diseases on basis of exercise testing alone may not be possible.

Effect of ipratropium bromide in bronchial asthma.

The effect of inhalation of ipratropium bromide was evaluated in 20 patients with bronchial asthma. It was observed that there was no significant improvement in the forced vital capacity and the forced expired volume in one second, while there was significant improvement in the peak expiratory flow rate (PEFR) measured at 9 pm, after inhalation of 2 puffs of ipratropium bromide aerosol (0.02mg/puff) three to four times a day for 2 weeks. Since PEFR is a measure of large airway function and cholinergic mechanisms are primarily involved for airflow obstruction at large airways, improvement in PEFR by ipratropium bromide highlights its role as a useful bronchodilator in patients in whom vagal reflexes are responsible for the provocation of bronchoconstriction.