Prevalence of asthma, atopy, and bronchial hyperreactivity in bronchiectasis: a controlled study

The prevalence of atopic diseases and bronchial reactivity to histamine and methacholine was determined in 36 patients with bronchiectasis and in 36 control patients matched for age, sex, and smoking history. There was no difference in the prevalence of asthma, other atopic diseases, family history of atopic diseases, or positive responses to skinprick tests (nine versus five) in the two groups. The prevalence of bronchial hyperreactivity, however, was significantly higher in the group with bronchiectasis than in the control group for both histamine (7 v 0 patients) and methacholine (6 v 0 patients). The group with bronchiectasis had more airflow obstruction (mean FEV1 67% predicted), but there was no correlation between spirometric indices and log PD20 (the log dose of histamine or methacholine causing a 20% fall in FEV1). This suggests that, although reduced airway calibre may be a factor underlying bronchial hyperreactivity in bronchiectasis, it is not the only mechanism. Further studies are needed to determine whether bronchial hyperreactivity has a causative role in the pathogenesis of bronchiectasis or whether it occurs as a result of the disease.

Therapeutic embolization of pulmonary arteriovenous malformation

A 49-year old man presented with recurrent transient ischaemic attacks and a pulmonary arteriovenous malformation (PAM) was found in his lower left lobe. Left lower lobectomy was performed, and the attacks ceased. However, 18 months later, a fresh PAM was detected in the right lower lobe. In order to avoid further lung resection, therapeutic embolization with metal-dacron coils and gelfoam was performed, resulting in complete occlusion of the PAM. The patient remained well at follow-up 6 months later. Therapeutic embolization is an effective alternative to surgery in the treatment of PAM, especially in the presence of multiple lesions when it is important to conserve functional lung tissue.

Diffusing capacity in healthy elderly Chinese

Diffusing capacity (DLCO) was measured in 260 healthy subjects aged 60-86 years who were leading an active life in the community. DLCO correlated with body surface area and spirometric indices, and declined with age. It was lower in women, in smokers and in those with chronic bronchitis. Multiple regression equations based on age and body surface area were derived for elderly Chinese men and women. Compared with predicted values based on studies of Caucasians of all ages, those for elderly Chinese men were higher, while those for elderly women were similar. Predicted values for an elderly Chinese population should be derived from equations established from this survey rather than those extrapolated from Caucasians of all ages. DLCO/VA correlated with weight and body surface area but not with height, and declined with age. There was no difference between men and women, and between those with or without symptoms of chronic bronchitis. Predicted values from this study of elderly Chinese were comparable to those derived from Caucasians of all ages. Differences in DLCO values for elderly Chinese compared to Caucasians may be explained by differences in lung volumes rather than ethnic variations in the diffusing characteristics of the alveolar capillary membrane, and by the small numbers of elderly subjects in some of the studies of Caucasian subjects.

Spirometry in healthy elderly Chinese

Forced expiratory volume (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF) were measured in healthy subjects (129 men, 210 women) aged 60 years and above who were leading an independent and active life in the community. Women but not men showed an age related decline in FEV1 and FVC. Correlations of FEV1 and FVC with height were weaker than those reported for all age groups. Male ex-smokers had lower FEV1 values than current smokers and non-smokers. Regression equations are derived for men and women for predicting values appropriate to Chinese elderly people. These values are slightly lower than those for white people, but the difference is not as great as in values derived from surveys of all age groups.

Metastasizing leiomyoma of the uterus

This report describes a patient who underwent a subtotal hysterectomy 6 years ago for fibroids. She re-presented recently with lung metastases and a pelvic mass. Macroscopic appearances at laparotomy suggested a leiomyosarcoma of the uterine stump, but histological appearances suggested the patient was suffering from the rare condition 'metastasizing leiomyoma'. Subsequent response to hormone manipulation supported the latter diagnosis.

Partial hospitalization. An alternative to inpatient care

Despite problems with research designs, sample sizes, differing areas of focus, and various research instruments, psychiatry can be encouraged by studies pointing to the following: Partial hospitalization can offer a viable alternative to inpatient hospitalization with less stigma and less family burden for patients. Such patients fare as well or better than their inpatient counterparts. When families or stable living situations are not available, the most acute patients can be treated and housed in a supervised living situation. Social and familial roles can be maintained. Partial hospitalization is helpful in reducing length and expense of full-time hospitalization when used as an transition to more traditional outpatient treatment and community life. This does not lead to increased rates of readmission or to exacerbating other symptoms or pathology. Partial hospitalization has grown steadily in the past 20 years. The question is no longer whether partial hospitalization works, but "what kind of patient can be best treated by partial hospitalization?" Innovative programs are sprouting. The 1980s bring fiscal, educational, and clinical challenges to partial hospitalization programs everywhere.

Coexisting retroperitoneal and mediastinal fibrosis

A rare case of coexisting retroperitoneal and mediastinal fibrosis is reported. Increasing awareness of this association may lead to earlier recognition of significant symptoms and more effective therapy.

Gastrointestinal haemorrhage from leiomyomata of the small bowel

Three cases of haemorrhage from small bowel leiomyomata are reported. The features and management of this rare, but important cause of life-threatening gastrointestinal bleeding, are discussed.