Chronic cough

Chronic cough is a common symptom presenting to all clinicians. Every effort should be made to determine the cause(s) of cough because specific therapy has a higher likelihood of success than empiric therapy. Evaluation begins with a complete history, physical examination, routine health screen laboratory testing, chest film, and pulmonary function testing. Further investigation should be guided by the response to treatment of the most likely diagnostic possibilities: postnasal drip, cough-variant asthma, gastroesophageal reflux, chronic bronchitis, bronchiectasis, and ACE inhibitor induced. The majority of each patient's workup can be performed and ordered by the primary care physician.

Care of the elderly and occupational health for staff in local nursing homes: quality issues

Describes a questionnaire sent to 11 of the 66 nursing homes in the Brighton Health Authority to compare the quality of care provided. These homes care for 242 patients (representing 13 per cent of the 1,728 places in Brighton nursing homes). Questions dealt with residential environment, occupational health, care and control of medicines, clerical services, procedures for prevention and control of infection, etc. Results are discussed and recommendations for further improvements made.

Whole-body gallium 67 scans. Role in diagnosis of sarcoidosis

Early studies of 67gallium (67Ga) scanning in sarcoidosis focused on the lungs as a measure of disease activity, likelihood of progression, and the advisability of corticosteroid therapy. The predictive value of pulmonary uptake proved to be limited, but there has been renewed interest in 67Ga scanning as a diagnostic aid with special attention to characteristic extrapulmonary uptake patterns. Review of whole-body 67Ga scans in 172 patients with sarcoidosis, 21 with lymphoma, and 51 with other disorders demonstrated distinctive cranial, mediastinal, and hilar uptake patterns in sarcoidosis patients. Bilateral hilar uptake occurred in 81 sarcoidosis patients (47%) but in no lymphoma cases. Increased lacrimal and/or salivary gland uptake was observed in 47.5% but lacked specificity. Uptake in peripheral lymph nodes was infrequent in sarcoidosis (5%) but common in lymphoma (57%). 67Ga scans are especially valuable in patients with uveitis and liver granulomas whose chest radiographs are normal or equivocal. 67Ga scans, unnecessary in typical cases of sarcoidosis, have an important diagnostic role by reducing the need for invasive biopsy procedures in asymptomatic patients.

Inhibition and recovery of mammalian respiratory ciliary function after formaldehyde exposure

Formaldehyde (HCHO) has been reported to impair mucociliary clearance. The present investigation using rabbit and porcine tracheal explants in vitro examined (1) the impairment of ciliary activity, an essential component of mucociliary clearance; (2) the reversibility of ciliary dysfunction after HCHO exposure; and (3) the mechanism by which ciliary activity is reduced by HCHO. HCHO treatment of rabbit tracheal rings significantly decreased zones of active ciliated epithelium in direct proportion to concentration and exposure duration. There was also a significant concentration-dependent reduction of ciliary beat frequency. Removal of HCHO permitted recovery of zones of ciliary activity to normal beat frequencies; greater inhibitory concentrations of HCHO required greater time for return of function. Treatment of porcine tracheae with increasing concentrations of HCHO for time periods inhibitory to rabbit ciliary activity correspondingly reduced the yield of cilia extractable from treated epithelium. Furthermore, the specific activity of ATPase of extracted ciliary axonemes was diminished with increasing HCHO concentration, indicating loss of function. A recovery period following identical exposures of the porcine tracheae to the lower HCHO concentrations resulted in normal yields of functionally intact ciliary axonemes. Similarly, a recovery period after the highest HCHO concentration produced more functional axonemes than obtained from exposed tracheae without a recovery period, although less than normal yields. Therefore, ciliary dysfunction elicited by a defined range of HCHO concentrations is reversible. The yield and functional integrity of ciliary axonemes from epithelium exposed to HCHO with a recovery period are significantly greater than those without such a recovery period, suggesting an alteration and subsequent repair of epithelial surface components following HCHO exposure.

An optimized fluoroenzymatic assay for the determination of angiotensin converting enzyme inhibitors in biological fluids

An easy, analytically sound fluoroenzymatic assay for angiotensin converting enzyme (ACE) inhibitors is described. Drug samples and standards are extracted with methanol and evaporated to dryness. Drug residues are then incubated with the substrate N-benzyloxycarbonyl-phenyllanyl-l-histidyl-leucine and human plasma ACE at 37 degrees C, pH 7.65, for 1 h. Fluorescence of the o-phthaldialdehyde derivatized product is measured at wavelengths of 365 nm (excitation) and 490 nm (emission). A computer program converts fluorescence to percent of ACE activity inhibited and correlates this percent inhibition with drug concentration. The ester prodrug enalapril (MK-421) was measurable at levels of a 1 ng ml(-1) in serum after base hydrolysis to enalaprilat. Lowest reliable detection limits for enalaprilat (MK-422) and lisinopril (MK-521) in serum were 0.7 ng ml(-1). This method is easily adapted to most other ACE inhibitors, is well suited to automation and avoids the use of radioactivity.

Computed tomographic diagnosis of pulmonary varix

A solitary pulmonary nodule was shown by dynamic computed tomography to be vascular, to be enhanced during the pulmonary venous phase, and to be in continuity with the left inferior pulmonary vein. The diagnosis of pulmonary varix was confirmed by pulmonary angiography, an invasive procedure that can be avoided in the future.

Polymorphonuclear leucocytes release a factor(s) that induces platelet aggregation and ATP release after interaction with insoluble and surface-fixed immune complexes

We have found that human polymorphonuclear leucocytes (PMN) can be stimulated by large aggregates (heat-aggregated IgG, chemically polymerized IgG, heavily aggregated human immune complexes) and by surface-bound immune complexes (IC) to release enzymes (lysozyme, beta glucuronidase) and a factor(s) able to induce platelet aggregation and ATP release from the platelets. Surface-bound IC were most effective in stimulating the release of this factor(s). We used several substrates for their preparation: plastic-adsorbed antigen. Sepharose-coupled antigen and polymerized antigen. The platelet-aggregating factor(s) released by IC-stimulated PMN and zymosan-stimulated PMN were compared for their susceptibility to inhibition by indomethacin. Both induced a first phase of platelet aggregation that was resistant to indomethacin, but the second phase of aggregation and the release of platelet ATP were inhibited to a variable degree, more pronounced in the case of the factor(s) released after PMN-IC interaction. The lack of inhibition of the early phases of aggregation induced by our factor(s) when platelets were simultaneously exposed to indomethacin suggests that the classical, phospholipid PAF is released under these experimental conditions. Although, further experiments will be necessary to fully characterize the factor(s) involved, our observations suggest a complex interrelationship between human PMN and platelet activation, which may play an important role in the sequence of events that mediate the tissue deposition of IC and appearance of inflammatory changes.

Photoreduction of sulfur dioxide by spinach leaves and isolated spinach chloroplasts

Labeled sulfur dioxide was found to be extensively absorbed by spinach (Spinacea oleracea L.) leaves. Labeled sulfides detected in leaf blades following fumigations with sulfur dioxide in light indicated that photoreduction of sulfur dioxide had occurred. Measurable proportions of this labeled sulfur was localized within the chloroplast fraction. Suspensions of isolated chloroplasts supplied with labeled sulfur dioxide contained labeled sulfides following a 30-minute illumination period in water-cooled reaction vessels. With reference to recent studies of the chloroplast sulfur reduction pathway, probable points of entry for sulfur dioxide and the subsequent release of hydrogen sulfide are discussed.