Determination of the absolute intensity of the 1205 keV γ-ray emission from 91Y.

A radiochemically pure solution of 91Y was produced by the thermal neutron fission of 235U followed by successive chemical separations to remove fission product impurities. The gamma emission rate of the 91Y 1205 keV gamma was measured using multiple high purity germanium gamma spectrometers previously calibrated for counting efficiency using a certificated mixed nuclide gamma standard. The activity concentration of the 91Y was subsequently standardised by liquid scintillation counting. From the combination the activity concentration and gamma emission intensity, the absolute intensity of the 1205 keV gamma emission was derived as 0.2297(39)%. This data agrees within the quoted uncertainties with the absolute intensity of 0.26(4)% published in nuclear data sheets A=91 (Baglin, 2013), but reduces the uncertainty by an order of magnitude.

Rapid onset of action of levocabastine eye-drops in histamine-induced conjunctivitis.

Levocabastine is a recently developed, potent H1-receptor blocker intended for topical application. Seventeen healthy non-atopic volunteers participated in this randomized, double-blind, placebo-controlled study undertaken to investigate the speed of onset of action, efficacy and tolerability of levocabastine eye-drops after a histamine challenge. The degree of histamine-induced ocular inflammation was found to be significantly less after administration of levocabastine compared with placebo. Furthermore, levocabastine was shown to be rapidly effective with an onset of action within 10 min. Levocabastine eye-drops were well-tolerated and no adverse reactions to the study drug were reported. Levocabastine eye-drops appear to be a valuable therapeutic approach for the treatment of histamine-mediated ocular allergies.

Carnitine deficiency associated with long-term pivampicillin treatment: the effect of a replacement therapy regime.

A 51 year old female developed a skeletal muscle myopathy after 3 months of pivampicillin therapy. Pivampicillin can cause carnitine deficiency due to the pivalic acid side group. Plasma carnitine content and the patients symptoms failed to improve significantly on discontinuing the drug. Oral carnitine replacement therapy was administered for 6 weeks but the patient's plasma carnitine levels responded only slowly to this treatment. It is suggested that pivampicillin inhibits uptake of carnitine from the gut and may either directly or indirectly depress endogenous carnitine synthesis. In such cases a more aggressive carnitine replacement regime is indicated and pivampicillin should be avoided in patients requiring long-term antibiotic administration.

Airflow limitation in sarcoidosis--a study of pulmonary function in 107 patients with newly diagnosed disease.

One hundred and seven patients with sarcoidosis attended for pulmonary function testing within 2 weeks of diagnosis. In four Stage 0, 42 Stage I, 32 Stage II, 26 Stage III and three Stage IV patients physiological abnormalities increased with increasing stage. The commonest abnormality, airflow limitation, occurred in 61 patients; a low transfer factor occurred in 29; a restrictive defect, the least common abnormality, occurred in seven. Fifty-nine patients and 30 of those with evidence of airways obstruction never smoked. None of the 52 patients with airflow limitation tested after bronchodilator inhalation demonstrated significant reversibility. All patients with obstruction had evidence of small airways narrowing. The majority had an FEV1/FVC ratio below 75%. Fourteen patients also had a low peak expiratory flow indicative of large airway narrowing. Airflow limitation occurs in all stages of sarcoidosis and should always be looked for in patients with sarcoidosis who have respiratory symptoms.

Blocking of histamine-induced conjunctivitis by the oral antihistamine, astemizole.

When histamine is applied topically to the eye it produces stinging and inflammation of the caruncle and bulbar and palpebral conjunctiva. This model has been employed in the present study to assess the ability of an oral antihistamine, astemizole, to attenuate the irritation and inflammatory signs. Astemizole 30 mg, taken orally once daily for 1 week, considerably lessened the stinging and significantly lowered the signs of inflammation caused by topically applied histamines.

Application of histamine-induced conjunctivitis to the assessment of a topical antihistamine, levocabastine.

In an animal model, topical application of levocabastine to the eye inhibits the inflammatory conjunctival response to topically applied histamine. This is so even at one-fourth the concentration at which levocabastine is normally dispensed. Total blocking of histamine response continues for 24 h and is then irregularly observable for an additional 72 h. Levocabastine may be absorbed through the conjunctiva to give systemically transmitted protection to the contralateral eye. Levocabastine is a potent competitor against histamine for conjunctival H1 receptors and should prove a useful, possibly long-acting drug for the reversal of inflammatory conjunctivitis and inhibition of its recurrence.

The influence of topical anaesthetic agent at bronchoalveolar lavage upon cellular yield and identification and upon macrophage function.

The influence of cocaine and lignocaine as local anaesthetic agent upon the results obtained at bronchoalveolar lavage was investigated. No differences were found. A functional activity of macrophages was assessed when the cells were stored in lavage fluid. A time-dependent decrease occurred which was related to lack of nutrients rather than the anaesthetic concentration.

Need for intravenous hydrocortisone in addition to oral prednisolone in patients admitted to hospital with severe asthma without ventilatory failure.

52 severely ill asthmatic patients requiring acute admission to hospital entered a double-blind placebo-controlled trial to determine whether intravenous hydrocortisone given in addition to high-dose oral prednisolone and standard bronchodilator therapy accelerated recovery. Patients who had been given parenteral steroids before admission, by comparison with those who had not received such treatment, had been deteriorating for a shorter period before admission, had received more injected or nebulised bronchodilator therapy, and had higher admission peak flows. As judged by peak flow measurements 24 h after admission, parenteral steroids had no effect on the outcome, irrespective of whether they were given before or after (ie, intravenous hydrocortisone) admission. There is no evidence for the continued use of intravenous hydrocortisone in addition to oral prednisolone and bronchodilator therapy in patients admitted to hospital with severe asthma without ventilatory failure.

A simple numerical discriminant in the follow-up of lung cancer.

Statistical analysis of laboratory data obtained during a study on a group of patients with lung cancer suggests that a simple numerical discriminant may have value in the follow-up of such patients. The discriminant is based on six common laboratory tests and is rapidly derived in the consulting room using a simple pocket calculator.

Bromocriptine in severe adult asthma--a negative report.

A pilot study had suggested that bromocriptine (a dopamine agonist) might be of benefit in severe asthma, particularly in patients with marked diurnal variation in peak flow. Two studies are reported: (1) a longterm double-blind, controlled trial comparing bromocriptine (B) with placebo (P) in patients with severe asthma and, (2) a withdrawal study in patients who had received known bromocriptine, with apparent benefit, for at least one year. Of 27 patients (16B, 11P) admitted to the double-blind trial only eight (4B, 4P) completed 52 weeks on the trial drug as nine (6B, 3P) had been withdrawn for side-effects, eight (4B, 4P) for failure and two (2B) for both reasons. The results, based on changes in steroid dosage and other medication, daily symptom scores and PEF values, suggest that bromocriptine has little effect in asthma. In addition side-effects were frequent and troublesome. In the withdrawal study, ten patients who had been taking bromocriptine for a year or more were switched to an indistinguishable placebo if their asthma was considered to be stable. The results, of this second study, support the conclusion of the double-blind study, that bromocriptine has little beneficial effect in asthma.

Spontaneous pneumothorax in Norfolk.

A Chest Unit's experience of spontaneous pneumothorax over a 14-year period has been analysed: 236 patients, the majority of whom were young males and were smokers, had a total of 315 episodes of spontaneous pneumothorax during this time. Ninety-five per cent were successfully treated at first attendance by observation alone or by intercostal tube drainage. The choice of treatment did not influence the recurrence rate. The remaining 5% were treated surgically. Altogether 37 pleural abrasions or pleurectomies were performed, half because the lung failed to expand with intercostal tube drainage and the remainder because of one or more further episodes. There were no recurrences following this procedure. When definitive surgery was not performed after a recurrence there was a 40% incidence of third episodes. There was no mortality. The results of this study confirm that the vast majority of cases can be treated successfully under medical supervision with a recurrence rate around 20%. Surgical intervention should be considered in those who have a second episode or when pneumothorax occurs on the other side.

Bronchial reactivity in asthmatic adults with normal spirometric values.

A comparison was made between airways obstruction produced by exercise. Hyperventilation of cold air, hyperventilation of room air, and inhalation of ultrasonically nebulised distilled water. Seven asthmatics with no airflow obstruction were studied together with seven normal controls. All four provocations produced comparable mean reductions in forced expired volume in one second in the asthmatic patients, but no reduction was obtained in the controls. Whereas exercise, hyperventilation of cold air, and hyperventilation of room air were associated with heat loss from airways, inhalation of nebulised distilled water was not. Inhalation of ultrasonically nebulised distilled water offers a simple additional diagnostic test for asthma. Changes in the osmolality of airway surface liquid may possibly be the common mechanism by which "fog" and hyperventilation produce bronchoconstruction.

Assessment of steroid responsiveness in patients with chronic airflow obstruction.

A simple steroid trial was conducted to assess whether 31 patients with chronic airflow obstruction would benefit from oral steroid therapy. Peak expiratory flow (PEF), forced expired volume in 1 s (FEV1), and ratio of FEV1, to forced vital capacity (FVC) were monitored during a 6-month period (when patients were on maximum bronchodilator therapy), after 2 weeks on placebo and after 2 weeks on prednisolone 30 mg daily. Patients also measured that PEF at home thrice daily. None had a significant degree of steroid reversible airflow obstruction. The preliminary observation period (of at least 3 months) is important to prevent an improvement being attributed to steroids, when it has in fact occurred spontaneously or is the result of bronchodilator therapy or cessation of smoking.