Chronic lung inflammation in victims of toxic gas leak at Bhopal.

Bronchoalveolar lavage (BAL) studies in 20 patients at Bhopal, 1.3 +/- 0.4 yr and 2.7 +/- 0.6 yr after toxic gas exposure had revealed that the lower respiratory tract inflammation had progressed from initial macrophage alveolitis to macrophage-neutrophilic alveolitis. The interval between the two lavages was 1.4 +/- 0.6 yr. BAL studies in a new group of 24 patients 5.1 +/- 1.0 yr after exposure had confirmed chronic inflammation of the lower respiratory tract as evidenced by macrophage-neutrophilic alveolitis in these subjects as well. Clinical, radiographic and pulmonary function abnormalities were persistent in a proportion of subjects in both groups. Fibronectin (FN) levels were estimated in BAL fluid in 41 patients. Elevated FN levels were seen in 12 (29.3%) subjects and nine of these 12 had radiographic abnormalities. Severely exposed subjects (n = 30) had significantly higher BAL fibronectin levels compared to normal subjects and mild/moderately exposed subjects. Repeat FN estimations in BAL samples from 10 patients had revealed that five had abnormally high FN including three who had high FN on both occasions. The number of patients showing abnormal decline in pulmonary function was higher in patients with elevated FN than in patients with normal FN. Thus, persisting clinical, roentgenographic and ventilatory abnormalities, as well as macrophage-neutrophilic alveolitis along with abnormally elevated FN levels in a proportion of subjects, suggest the possibility that lung fibrosis can occur in subjects exposed to toxic gas at Bhopal.

A comparative study of flurbiprofen and piroxicam in osteoarthritis.

In this single-blind, multiple-dose study the efficacy and tolerability of flurbiprofen was compared with that of piroxicam in 60 adult patients suffering from osteoarthritis of the knee. The patients were randomly allocated to receive either flurbiprofen 100 mg twice daily or piroxicam 20 mg once daily for a period of four weeks. Clinical assessments w.r.t. pain, tenderness, stiffness, swelling and general activity of patient were carried out prior to initiation of trial therapy and thereafter at weekly intervals for four weeks. The findings were graded. Though significant improvements as compared to baseline data occurred in both the treatment groups, flurbiprofen was found to be superior to piroxicam in improving pain on movement and at rest (p < 0.05). The incidence of side effects was less in the group receiving flurbiprofen (6% compared to 47% observed with piroxicam).

Enalapril in hypertension.

Twenty five patients of mild to moderate uncomplicated essential hypertension and five with severe hypertension were treated with long acting converting enzyme inhibitor enalapril for six weeks. Diuretic was added in those patients who did not respond satisfactorily. Twenty one patients of mild to moderate hypertension had their diastolic blood pressure controlled at the end of the study; fifteen with enalapril alone and six with the help of diuretic. Remaining four showed a relative fall but not to level below 150/90 mm Hg. Only one patient with severe hypertension showed fall to normal levels. Four showed a relative fall but not to the normal level even with the addition of a diuretic. Enalapril is an effective anti hypertensive drug in mild to moderate essential hypertension.

Value of DOPEG estimation in CSF in depression.

3,4-Dihydroxyphenyl ethylene glycol (DOPEG), a metabolite of noradrenaline (NA), was estimated in CSF of 30 patients of depression diagnosed by the criteria of American Psychiatric Association in DSM-III; and compared with levels in 10 non-depressed individuals who served as controls. Mean DOPEG levels in CSF in the patient group (801.37 +/- 28.09 micrograms/l) were significantly higher (P less than 0.01) than those in the control group (724.3 +/- 34.62 micrograms/l). Formation of excessive amount of this particular metabolite suggests an excessive intraneuronal deamination of NA, partially accounting for the overall decline in the availability of NA in the noradrenergic neurons in patients of depression.

Bronchoalveolar lavage study in victims of toxic gas leak at Bhopal.

Bronchoalveolar lavage using flexible fibreoptic bronchoscope was carried out in 50 patients 1-2 1/2 yr after exposure to the 'toxic gas' at Bhopal. Thirty six patients in the analysis were categorised into 3 groups (viz., mild, moderate and severe), depending upon the severity of exposure. There was an increase in cellularity in the lower respiratory tract (alveolitis) of the severely exposed patients (in both smokers and non-smokers), compared to normals (P less than 0.05). The increase in cellularity in severely exposed non-smokers was due to abnormal accumulation of macrophages (P less than 0.01), and in severely exposed smokers, to macrophages (P less than 0.01) and neutrophils (P less than 0.05). Mild and moderately exposed patients did not show significant change in cellularity in lower respiratory tract, compared to normal individuals (P greater than 0.2). There was a trend towards increasing cellularity, as the severity increased (P less than 0.0001) and higher numbers of total cells were seen in severely exposed smokers, suggesting that smoking is a risk factor. It appears, therefore, that subjects severely exposed to the toxic gas at Bhopal may have a subclinical alveolitis characterised by accumulation and possibly activation of macrophages in the lower respiratory tract. Smokers, who were exposed to the gas had in addition, accumulation of neutrophils.

Patterns of recovery of pulmonary functions in severe acute bronchial asthma.

The recovery of pulmonary function were studied in fifty patients of acute bronchial asthma receiving a standard therapeutic regime. Sixty-two per cent of patients had achieved 50% of their total improvement in peak expiratory flow rate (PEFR) within 24 hours (fast responders) as against slow responders. Duration of asthma, characteristics of present exacerbation, mean pulse rate and presence of pulsus paradoxus on admission did not differ in fast and slow responders. The rise in PEFR within 4 hours of starting treatment was highly significantly correlated with a higher PEFR at 24 hours and a faster recovery. The mean arterial PaCO2 was higher (P less than 0.02) in slow responding group and they were slightly older (P less than 0.01), had lower mean FVC (P less than 0.01), mean FEV1 (P less than 0.02) and PEFR (P less than 0.001). The mean PaO2 of less than 80 mm Hg at 48 hours was more common in those with delayed recovery of PEFR.