[Recurrent pleurisy as sole manifestation of familial Mediterranean fever]. / Recidiverende pleuritis als enige uiting van familiale mediterrane koorts.

Recurrent pleurisy as sole manifestation offamilial Mediterranean fever. An 18-year-old woman of Turkish descent visited our outpatient department with a 12-year history of recurrent self-limiting febrile attacks accompanied by chest pain. At first the symptoms were attributed to recurrent lower airway infections. However, the persistent nature of the attacks combined with her ethnic background and the spontaneous recovery from the short paroxysmal episodes, led to the consideration of familial Mediterranean fever (FMF). After undergoing treatment with colchicine the patient was free of symptoms. Later it became clear that her 28-year-old brother had the same clinical manifestations of FMF. He was also successfully treated with colchicine. The often long interval from disease onset to correct diagnosis reflects the unfamiliarity of physicians with this disease and the frequency with which it is confused with other syndromes. In patients with paroxysmal febrile attacks and chest pain, especially if they originate from the eastern Mediterranean area, FMF should be considered and colchicine be prescribed to relieve symptoms and prevent amyloidosis.

Long-term treatment of chronic obstructive pulmonary disease with salmeterol and the additive effect of ipratropium.

The efficacy and safety of salmeterol alone was compared with the combination of salmeterol plus ipratropium and with placebo during long-term treatment in patients with stable chronic obstructive pulmonary disease. In addition, the single-dose effect in response to the first dose of treatment was studied over 12 h. The patients (n=144; age 64+/-7 yrs, forced expiratory volume in one second (FEV1) 44+/-11% pred) participated in a three-centre double-blind double-placebo parallel group study and were randomized after a run-in period of 2 weeks to receive either salmeterol 50 microg b.i.d., salmeterol 5 microg b.i.d. plus ipratropium 40 microg q.i.d. or placebo for a period of 12 weeks. The single-dose study demonstrated that salmeterol produced a significant increase in FEV1 (peak of 7% pred) and specific airway conductance (sGaw) (maximum of 60% baseline) for > or =12 h. The combination of salmeterol plus ipratropium elicited a greater bronchodilator response (11% and 94% increases respectively) than salmeterol alone during the first 6 h after inhalation. During treatment there were significant improvements in daytime symptom scores and morning peak expiratory flow in both the salmeterol and the salmeterol plus ipratropium groups (p<0.001), with an associated decrease in the use of rescue salbutamol. Improvements in FEV1 and sGaw were greater in the salmeterol plus ipratropium group than in the patients receiving only salmeterol. Thirty-five patients had an exacerbation; 11 (23%) in the salmeterol group (versus placebo NS), six (13%) in the salmeterol plus ipratropium group (versus placebo p<0.01) and 18 (36%) in the placebo group. In conclusion, in patients with severe stable chronic obstructive pulmonary disease, long-term treatment with either salmeterol alone or salmeterol plus ipratropium is safe and effective. There was added benefit from the combination therapy in terms of improvement in airways obstruction, but not for improvement in symptom control or need for rescue salbutamol.

[Pulmonary damage after radiotherapy for breast cancer]. / Longschade na radiotherapie voor mammacarcinoom.

Radiation therapy for breast cancer can cause pulmonary damage. This was diagnosed in two patients aged 75 and 57 years respectively. They had different types of radiation pneumonitis. The first patient presented with a so-called bronchiolitis obliterans organizing pneumonia (BOOP), four months after radiation therapy. Characteristic in BOOP are the bilateral and migrating lung infiltrates that are distributed predominantly in the middle and lower lung zones. The second patient developed a pneumonitis that classically was confined to the area of irradiation four months after radiation therapy. The two types of radiation pneumonitis can be treated successfully with corticosteroids. If symptomatic radiation pneumonitis is diagnosed early it can be treated well and than has a good prognosis.

Factors related to outcome after pneumonectomy: retrospective study of 62 patients.

OBJECTIVE: To find out which risk factors affect outcome after pneumonectomy. DESIGN: Retrospective study. SETTING: Teaching hospital, The Netherlands. SUBJECTS: 62 patients who were treated for bronchial cancer by pneumonectomy between 1984 and 1995. MAIN OUTCOME MEASURE: Hospital mortality and postoperative complications. RESULTS: Hospital mortality increased with age, being 5/51 (10%) in the 40-69 age group and 4/11 (36%) in patients aged 70 or more. In the American Society of Anesthesiologists (ASA) class I group hospital mortality was 8% (2/26), in class II 12% (3/26) and in class III 40% (4/10). Hospital mortality was highest when the FEV1:FVC-ratio was below 55%. Cardiac arrhythmias developed in 8 (13%), early bronchopleural fistulas in 7 (11%), and postpneumonectomy syndrome in 5 (8%). These major complications had a high mortality. CONCLUSION: Respiratory function, ASA class, and age over 70 years are the main prognostic factors for hospital morbidity and mortality after pneumonectomy.