Follicular conjunctivitis on Dipivefrin therapy for glaucoma.

Dipivefrin (Propine) is an effective ocular hypotensive agent. Follicular conjunctivitis has been observed in an unexpectedly high incidence of glaucoma patients on this topical therapy. Severe discomfort was experienced by a few patients. Follicles resolved after withdrawal of this medication, but may persist or recur upon subsequent treatment with other adrenaline related compounds. Regular examination of the conjunctiva is recommended for early signs of this side-effect, which initially may be symptom free.

The influence of anaesthesia on the acute phase protein response to surgery.

The influence of anaesthesia on the peri-operative changes in acute phase protein concentrations was studied in 18 patients undergoing elective cholecystectomy. A standard anaesthetic technique was supplemented either by one of two different doses of fentanyl, or by halothane. Eleven proteins were studied but the acute phase response was significantly altered by the anaesthetic technique for only two, fibrinogen and antichymotrypsin. The concentration of these proteins tended to be lower with 2-3 micrograms/kg fentanyl than with either halothane or fentanyl 12 micrograms/kg. There was no evidence of variation in stress suppression between the three techniques. The mechanism of any anaesthetic influence on the acute phase response is uncertain and this study is too small to assess its clinical significance.

Some predisposing factors to hypersensitivity reactions following first exposure to Althesin.

Three possible factors predisposing to Althesin hypersensitivity, namely total dose, method of administration, either by bolus dose or infusion, and pregnancy have been studied in patients receiving the drug for the first time. Of 137 patients given Althesin, four exhibited clinical signs of mild hypersensitivity, while C3 conversion alone, indicative of a subclinical reaction, was seen in a further six patients. No reactions were observed in two control groups in whom anaesthesia was induced with thiopentone. Neither the total dose nor method of administration appeared consistently to influence the incidence of reactions, but eight of the ten patients producing an altered response to Althesin were pregnant.

Effect of varying methods of upper limb occlusion on fibrinolytic activity in man.

Three techniques of intermittent venous occlusion (an oscillotonometer cuff, pneumatic leggings and an automatic arterial pressure monitoring cuff (Sentinel] were applied to one upper limb of seven healthy male volunteers. Fibrinolytic activity was assessed by the measurement of the euglobulin clot lysis time during a control period followed by 1 h of intermittent venous occlusion. Although no statistically significant differences were found with any of the methods, between the control and experimental periods, there was a trend towards fibrinolytic enhancement with intermittent pneumatic compression.

Immunological aspects of adverse reactions to althesin.

Sequential plasma samples from 30 patients showing clinical signs of hypersensitivity to Althesin were investigated to determine if a specific immune response to the drug was present (as measured by classical complement pathway activation) or if a non-antibody-dependent alternative complement pathway activation was taking place. The patients were classified as those reacting on first exposure to Althesin and those who reacted adversely only on a second exposure. The alternative complement pathway, but not the classical pathway, was activated in five of the 13 first-time reactors, while in the remaining eight no complement activation was detected. In contrast, classical complement pathway activation was demonstrated in the blood samples of all 17 patients reacting on repeat exposure. Severe reactions occurred in nine of the 17 previously exposed patients compared with only one of the 13 reacting on first exposure to Althesin.