The effect of aminophylline on cardiac rhythm in advanced chronic obstructive pulmonary disease: correlation with serum theophylline levels.

The effect of IV aminophylline on cardiac rhythm of patients with advanced, stable chronic obstructive pulmonary disease (COPD) was evaluated with Holter monitoring in 38 males (average age 62 yrs). Serum levels ranged from 7.4 to 18.6 mg/l. Significant improvement in pulmonary functions and blood gases from baseline measurements were observed. New supraventricular tachycardia was seen only in three (8%) of 38 patients. Sixteen (76%) of the 21 patients with insignificant ventricular ectopy (VE) at baseline remained unchanged during therapy. Of the 17 patients who had significant baseline VE, nine (53%) had increased VE and eight (47%) had decreased VE. No symptomatic arrhythmia was observed. Whereas aminophylline in therapeutic dosage failed to provoke VE in arrhythmia-free COPD patients, the effect of aminophylline on pre-existent VE is variable.

Intracavitary amphotereicin B in the treatment of symptomatic pulmonary aspergillomas.

The optimal treatment of pulmonary aspergillomas is not established. Surgical resection is often impossible because of severe, underlying pulmonary impairment, and medical treatment has given negative or inconclusive results. Six patients with symptomatic pulmonary aspergillomas were treated with percutaneous instillation of intracavitary amphotericin B. Four patients who received the full course of therapy showed improvement and stabilization or reversal of progressive roentgenographic changes. Also, follow-up serologic studies of Aspergillus spp. precipitins were obtained in three and were negative. One patient did not tolerate this treatment because of repeated systemic reactions. Another patient did not respond clinically or roentgenographically. Intracavitary amphotericin B therapy should be considered in patients with symptomatic pulmonary aspergilloma, particularly when surgical resection is not feasible.