Leptospirosis associated with severe pulmonary haemorrhage in Far North Queensland.

Pulmonary haemorrhage as a manifestation of leptospirosis is rarely diagnosed in developed countries. Five patients with proven leptospirosis associated with severe pulmonary haemorrhage presented to one hospital in Far North Queensland between January 1994 and June 1997. Four required admission to the intensive care unit and one patient died. Pulmonary haemorrhage is an uncommon but severe complication of leptospirosis and may be a source of diagnostic confusion in tropical areas of Australia.

Low-dose tretinoin does not improve striae distensae: a double-blind, placebo-controlled study.

Striae distensae occur on the abdomen and/or breast in 90 percent of all pregnant women and are the result of extrinsic and intrinsic factors. This study investigated the response of pregnancy-related abdominal striae to treatment with tretinoin cream (0.025 percent) applied daily for seven months. In this study, eleven subjects were randomly assigned to tretinoin or placebo treatment groups. Before and after photographs were evaluated by a standardized system. There was no difference or improvement in the treated group compared with control subjects. Tretinoin 0.025 percent cream was ineffective in improving striae distensae in these subjects.

Pulmonary haemosiderosis associated with left atrial myxoma.

A patient with features suggesting pulmonary haemosiderosis was found to have a myxoma. The pulmonary lesion cleared after excision of the tumour.

The use of high dose inhaled beclomethasone dipropionate as a means of assessing steroid responsiveness in obstructive airways disease.

The use of high dose inhaled beclomethasone dipropionate (BDP) as a means of assessing steroid responsiveness in chronic obstructive airways disease (COAD) was assessed in 22 patients in a study involving three consecutive 2-week periods of placebo, inhaled BDP (1500 micrograms daily), and oral prednisolone (30 mg daily). Five of the 22 patients were considered steroid responsive following the course of oral corticosteroids and in each case this responsiveness had been identified by inhaled BDP therapy. It is concluded that high dose inhaled BDP (1500 micrograms daily) may be used to assess corticosteroid responsiveness in COAD.

General practitioner referrals for static miniature chest radiography: indications and diagnostic yield.

The chest clinic based miniature radiographic service had been studied prospectively with the view to assessing its efficiency and correlating radiological and clinical findings. We conclude that such a service provides advantages for rapid patient recall and assessment. The fact that it is organized by chest physicians allows a more selected pattern of clinic referral.

The effects of beta-adrenoceptor blockade on breathing during progressive exercise in normal man.

1 We have studied the effects of single oral doses of 80 mg propranolol and 100 mg atenolol on breathing during progressive exercise in nine healthy men in a double-blind, placebo-controlled experiment. As judged by their effects on exercise heart rate significant levels of beta-adrenoceptor blockade were achieved. 2 At the two lower levels of work rate (50 watts and 100 watts) minute ventilation on atenolol was lower than on placebo while at the highest level of work (200 watts) minute ventilation was higher on atenolol than on placebo. The regression of VE atenolol on VE placebo was 1.28 which is significantly different from unity (P less than 0.001). The results with propranolol were more scattered and failed to reach the 5% level of significance. 3 Effects on the pattern of breathing are small but when minute ventilation is matched with placebo, atenolol results in larger tidal volumes and prolonged inspiratory and expiratory time. 4 These observations are discussed in relation to other work in the literature.

Audit of work-load of physicians with a special interest in respiratory medicine.

A 6-month prospective survey was undertaken to assess the work-load of two consultant general physicians with special interest in respiratory medicine, one in a teaching hospital (TH) and the other in a district general hospital (DGH). The two firms dealt with similar numbers of inpatients of whom half had non-respiratory disease. Eighty per cent of the outpatient work of both firms was respiratory disease. The TH firm saw more referrals from other consultants and referred more patients, especially to other physicians. Practical procedures performed, the proportion of patients seen by the consultant at first attendance and the range of both respiratory and general medical conditions seen by the two firms was similar.

The distribution of gluten-sensitive lymphocytes in coeliac patients--is it related to dietary gluten?

Cell-mediated immunity to gluten within the peripheral blood and jejunal mucosa of the same coeliac patients was measured simultaneously using migration inhibition tests. There was an inverse correlation in migration indices indicating that as cell-mediated immunity became more detectable in the peripheral blood, it was less so in the jejunal mucosa and vice versa. There was virtually no relationship, however, between this correlation and the gluten content of the diet in these coeliac patients.

Postal survey of bronchoscopic practice by physicians in the United Kingdom.

In 1983 a postal survey of the bronchoscopic practice of chest physicians in the United Kingdom produced a 90% response rate. Two hundred and thirty one physicians were carrying out bronchoscopy; they had performed about 40 000 bronchoscopies in the preceding year, 87% of these being fibreoptic procedures with topical anaesthesia. The mortality rate of fibreoptic bronchoscopy was 0.04%, with a 0.12% incidence of major complications. Transbronchial biopsy carried both an appreciably higher mortality rate of 0.12% and a major complication rate of 2.7%. There is wide variation in the use and choice of sedative drugs for fibreoptic bronchoscopy. Many of the drug combinations could be criticised on pharmacological grounds. The mean dose of lignocaine was 342 mg, most operators exceeding the usual maximum recommended dose; but adverse reactions were rare. Routine supplemental oxygen was given by only 18% of bronchoscopists. Basic resuscitation equipment was often inadequate. Radiological screening was used for transbronchial lung biopsy by 53% of respondents and significantly reduced the incidence of pneumothorax from 2.9% to 1.8%. Both the number of bronchoscopies performed and the complication rate were higher than previous estimates. Bronchoscopists should re-examine their policy on drugs and safety precautions to minimise the risks of the procedure.

Pancoast's syndrome associated with invasive aspergillosis.

The combination of lower brachial plexus root pain in the shoulder and arm and of ipsilateral Horner's syndrome was described by Pancoast in 1932 and is usually caused by a malignant tumour at the apex of the lung. We describe a case in which the syndrome occurred in an immunosuppressed patient and was due to invasive fungal infection.

Chest pain--indigestion or impending heart attack?

A high proportion (40%) of patients with definite myocardial ischaemia who were questioned on admission to a Cardiac Monitoring Unit had experienced preceding chest pain which had been misinterpreted by both the patients themselves and doctors as 'indigestion' and which had often been inappropriately treated. 'Indigestion' in the chest in previously non-dyspeptic subjects over 40 years of age should be regarded as myocardial ischaemia until proved otherwise.

Are all gliadins toxic in coeliac disease? An in vitro study of alpha, beta, gamma, and w gliadins.

The toxicity of alpha, beta, gamma, and w gliadins for small-intestinal mucosa has been assessed by means of an organ culture technique. The results suggest that all these gliadin fractions are toxic to coeliac mucosa in vitro.

Jejunal biopsy and lymphocyte co-culture in coeliac disease.

Jejunal biopsies from 13 patients with treated coeliac disease were maintained in organ culture for 24 h with and without the addition of gluten fraction III, in each case with and without autologous peripheral blood mononuclear cells. Biopsies cultured with gluten alone or with lymphocytes alone showed no significant reduction in mean enterocyte height compared with those cultured in control medium, but those cultured with both gluten and lymphocytes had significantly lower enterocyte height than control biopsies, than those cultured with gluten alone, and than those cultured with lymphocytes alone. These results demonstrate that the combination of gluten and lymphocytes is more toxic to treated coeliac mucosa in vitro than either one alone and support the suggestion that immune reactions to gluten may be important in the pathogenesis of the mucosal lesion of coeliac disease.

Splenectomy causes auto-antibody formation.

Serum from 45 splenectomised patients was screened for 8 auto antibodies and compared with controls, either age and sex matched (35) or the same patients measured before splenectomy (10). Sixteen splenectomised patients had demonstrable auto-antibodies compared with 7 controls (p less than 0.05). Three patients who did not have auto-antibodies before splenectomy developed them after an interval of a few months. It is suggested that splenectomy-leads to loss of suppressor cell activity and this permits the development of auto-antibodies.