Profiles of non-compliance with antituberculous therapy.

Treatment compliance was assessed by testing multiple urine samples for rifampicin in 113 consecutive patients taking a rifampicin containing regimen for tuberculosis. Nineteen (16.8%) patients had at least one negative urine sample after chromatographic analysis and these patients were more likely to be from social classes IV and V, to be Asian, and to have defaulted from at least one clinic appointment without good reason. A questionnaire was completed by 70 of the patients and four (6%) admitted to having omitted at least one treatment weekly; two of these also had at least one negative urine test. Physicians were only partly successful in identifying non-compliers. The relevance of these findings is discussed.

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.

The diagnosis and treatment of adults with obstructive airways disease in general practice.

Two hundred and one patients diagnosed by their general practitioners as having asthma and 113 as having chronic bronchitis were compared by symptomatology and airways reversibility. Though the majority of patients given these two diagnoses could be separated by symptom complex, in about one-third such differentiation was difficult. There was no significant difference in bronchodilator reversibility between the asthmatics and chronic bronchitics. Nine out of 15 (60%) asthmatics and four out of 18 (22%) chronic bronchitics responded by 15% or more to a course of oral corticosteroid drugs. The majority of corticosteroid responders had been undertreated. The problems arising from the poor correlation between airways reversibility and symptomatic diagnosis are discussed.

Recurrent pleural fibroma.

Pleural fibromata are rare tumours. We report a case of histologically proven pleural fibroma with later recurrence following resection. The case emphasizes the need for long-term review of patients with pleural fibromata.

Long term study of the effect of rifampicin and isoniazid on vitamin D metabolism.

Eight patients with tuberculosis were studied before, during and after 9 months treatment with rifampicin and isoniazid to assess the overall effect on vitamin D metabolism. No significant uniform change in either 1,25(OH)2D or 25 OH D nor in any of the other biochemistry measured occurred during the study. It seems unlikely that the combined effects of these drugs causes clinically significant derangement of vitamin D metabolism in patients treated over a 9 month period for tuberculosis.

Pulmonary infiltrates and adult acute leukaemia: empirical treatment and survival related to the extent of pulmonary radiological disease.

In a retrospective review of 141 consecutive adult patients with acute leukaemia there were 33 local and eight diffuse parenchymal pulmonary abnormalities noted on the first abnormal chest radiograph. Empirical treatment was given without any invasive diagnostic procedures. Twenty of the 41 patients (49%) with radiographic abnormalities died--10 of 31 patients (32%) in the "local" group (excluding two who were not actively treated) and all eight patients in the "diffuse" group. One patient in the local group and six in the diffuse group died within 48 hours of the first abnormal chest radiograph. The results in the local group suggest that failure to respond to the initial treatment prescribed would allow time to perform an invasive procedure in most patients that may lead to a change in management. In the diffuse group, however, an early invasive procedure would be required if the result were to have a chance to influence the outcome.

The diagnosis of pleural effusions--are cancer markers clinically helpful?

We submitted 83 consecutive patients with pleural effusion to routine clinical investigation; 57 were diagnosed as malignant, 18 as benign, and 8 were not diagnosed. Pleural fluid and serum were analysed for carcinoembryonic antigen (CEA), acid glycoprotein (AGP), antichymotrypsin (ACT), C-reactive protein (CRP), alpha 2-pregnancy associated glycoprotein (alpha 2-PAG) and ferritin. Multivariate discriminant analysis was performed on the results of the protein measurements. CEA and ACT values in serum and fluid were found to give a good discriminating function between the benign and malignant groups. The use of such an analysis, in a clinical context, is discussed.

Unusual pulmonary reactions to oily propyliodone (Dionosil) in bronchography.

Severe reactions to oily propyliodone are rare. Side-effects are usually mild and self-limiting. Three cases are reported of early pulmonary reactions, the cause of which may be a chemical pneumonitis or possibly an allergic response to one of the components of the contrast medium. There was a good response to corticosteroid therapy in all three patients.