How well do the general public read Heaf skin tests?

The ability of 550 consecutive patients attending a tuberculosis clinic to grade their own Heaf skin test reaction, using an illustrated card designed for such self-reporting, was assessed. Individuals were asked to grade their own Heaf skin reaction and at the same attendance the reaction was formally graded by a respiratory health visitor. There was overall excellent agreement with only 58 (10.5%) disparate gradings. We conclude that self-reporting of Heaf skin tests using an illustrated card is simple, usually accurate and may preclude an otherwise unnecessary early reattendance. This study also validates an often used system of self-reporting.

Chemosensitivity testing of human gliomas using a fluorescent microcarrier technique

This report describes a new fluorescent microcarrier cytostasis assay. Human glioma cell lines and primary cultures were attached to microcarrier tissue culture beads and treated with various chemotherapeutic drugs. After treatment, the cells were labelled with two vital fluorescent dyes in order to measure cellular viability. The uptake of hydroethidine and Hoechst 33342 was evaluated alone and in combination as probes for determining metabolic activity and cellular proliferation. Hydroethidine was found to be superior when compared to trypan blue and tritiated thymidine. The use of the microcarrier technique allows for the direct cellular measurement of fluorescence without the need of extensive extraction procedures. The fluorescent assay is a sensitive, rapid and an effective way to screen for potential antiproliferative compounds.

The use of probenecid to increase the serum amoxycillin levels in patients with bronchiectasis

Amoxycillin 3 g twice daily is effective in treating patients with bronchiectasis who have daily purulent sputum. However, it is a relatively expensive treatment if used for prolonged periods. This pilot study in six patients with bronchiectasis showed that the concurrent administration of probenecid with a smaller dose of amoxycillin produced similar clinical responses and pharmacokinetic profiles to those found with high dose amoxycillin alone. The amount of amoxycillin used was reduced by two thirds, producing a potential saving of approximately pound 1000 per patient per annum in those taking long term treatment.

Hypercalcemia in atypical bronchial carcinoid tumors

Atypical carcinoid tumors of the bronchial tree are uncommon. Their tendency to metastasize is well recognized, characteristically producing osteoblastic bone deposits without disturbance of calcium homeostasis. We report two patients who presented with hypercalcemia and osteolytic bone metastases following surgical removal of atypical bronchial carcinoid tumors. In one of the patients, chemotherapy induced remission and controlled the hypercalcemia.

Respiratory symptoms and pulmonary impairment in male and female subjects with pottery workers' silicosis

Respiratory symptoms, smoking habit, lung function and radiological category of silicosis were assessed in 276 present and former pottery workers who were receiving industrial disablement benefit for silicosis. There were 140 females and 136 males. The proportion with conglomerate disease (massive fibrosis) was similar in both sexes. The FEV1 declined with increasing X-ray category of silicosis irrespective of smoking habit and was most marked in subjects with symptomatic chronic bronchitis. In females who had never smoked the average decline of FEV1 in those with simple silicosis was 18 ml year-1 and for those with conglomerate disease 38 ml year-1. Symptomatic chronic bronchitis was common and only partly related to smoking, occurring in 69% of 101 nonsmoking female silicotic patients. No significant changes were observed in vital capacity, lung volume or transfer factor for carbon monoxide.

Clinical features of the sleep apnoea/hypopnoea syndrome

The sleep apnoea/hypopnoea syndrome has been reported to be rare in Britain. We have offered a clinical service for the diagnosis and treatment of this condition in Scotland for four years during which there has been an increase in referral rate from 19 patients in year 1 to 61 in year 4. We report the clinical features of the 80 patients. Seventy-eight snored and 70 were somnolent, each falling asleep at least once each day when not in bed. Ten reported falling asleep whilst driving or flying. Twenty-nine slept restlessly, 28 were not refreshed by sleep and 21 had nocturnal choking attacks. Ankle swelling was reported by 26 and 25 were hypertensive (diastolic BP greater than 95 mmHg). Two had hyperthyroidism and one acromegaly. Nineteen have been successfully treated by continuous positive airway pressure therapy at home. The data suggest that regional centres should be established in Britain to diagnose and treat this condition.

Optimal duration of radiological follow-up for tuberculosis contacts

Eight hundred and sixty Heaf test positive contacts of cases of tuberculosis in Lothian were offered screening with chest radiographs for the recommended period of two years. In spite of the use of standard methods of encouragement to attend, only 309 (35.9%) completed the two year period of follow-up. Seven cases of tuberculosis (representing a crude rate of eight cases per 1000 contacts) were detected radiologically, all within 3 months of entering the screening programme. In view of the poor compliance with the extended period of follow-up and the detection of all cases early in the screening process, we recommend that, at least in Lothian, radiological follow-up of Heaf positive tuberculosis contacts need only be applied for a period of 6 months.

Peripheral nerve function in patients with chronic bronchitis receiving almitrine or placebo

A double blind prospective study of the effect of almitrine bismesylate and placebo on peripheral-nerve function was carried out in 12 patients with chronic bronchitis and arterial hypoxaemia (mean (SD) FEV1% predicted 38 (16), arterial oxygen tension (PaO2) 7.56 (0.76) kPa). Of the seven patients who took placebo, none developed symptoms or signs of peripheral neuropathy. One patient who had abnormal lower limb sensory nerve conduction initially showed improvement of sensory conduction but deterioration in motor conduction during the 12 month study period. Two further patients developed some slowing of motor conduction velocities in their right lateral popliteal nerve. Five patients received almitrine and all showed an improvement in PaO2 (mean from 7.0 to 7.9 kPa). None had symptoms or signs of peripheral neuropathy on entry to the study; one patient had evidence of impaired nerve conduction on electrophysiological testing. Three patients developed symptoms and signs of peripheral neuropathy during the 12 months of the study and a fourth developed peripheral neuropathy at 18 months, having continued to receive almitrine. Studies of nerve physiology showed abnormalities in the lower limbs of all four patients. Recovery was poor, possibly because of the long half life of almitrine. The studies suggest that almitrine may precipitate peripheral neuropathy in patients with chronic obstructive pulmonary disease. Patients should be warned of this potential complication so that the drug can be stopped as soon as symptoms develop.

Immunocytochemical study of transforming growth factor expression in benign and malignant gliomas

Immunocytochemical studies using polyclonal antibodies to epidermal growth factor (EGF) and transforming growth factor (TGF) alpha and beta were performed on 20 cases of human gliomas. EGF immunoreactive material was detected in both benign and malignant glial tumors. In addition, EGF immunoreactive material was detected in normal brain. TGF-beta was detected in both benign and malignant tumors, but was not detected in normal brain. In contrast, TGF-alpha was highly conserved in its expression, occurring predominantly in malignant compared with benign or normal brain tissue (P less than 0.0001). In malignant gliomas, glioblastomas contained 76% TGF-alpha reactivity (immunoreactive product), and anaplastic types contained 85% reactivity. Benign gliomas contained only 13% TGF-alpha reactivity. These findings support the role of TGF-alpha as an oncoprotein marker in brain neoplasms.

Bacteraemic Haemophilus influenzae pneumonia

Bacteraemia with Haemophilus pneumonia is uncommon. To determine its incidence and features case notes of patients in whom Haemophilus spp. were isolated from blood and pleural fluid over a five-year period were reviewed. Eight adult patients with H. influenzae bacteraemia were identified, five of whom had pneumonia on clinical and radiographic criteria. Only one patient had a predisposing factor, chronic obstructive lung disease. Two patients had beta-lactamase producing isolates, one of whom developed an empyema, following treatment with ampicillin, which required surgical drainage. Four patients were elderly, aged 69-80 yrs and were clinically in shock at the time of diagnosis. Seven of the eight patients survived.

Bacteraemic Haemophilus influenzae pneumonia

Bacteraemia with Haemophilus pneumonia is uncommon. To determine its incidence and features case notes of patients in whom Haemophilus spp. were isolated from blood and pleural fluid over a five-year period were reviewed. Eight adult patients with H. influenzae bacteraemia were identified, five of whom had pneumonia on clinical and radiographic criteria. Only one patient had a predisposing factor, chronic obstructive lung disease. Two patients had beta-lactamase producing isolates, one of whom developed an empyema, following treatment with ampicillin, which required surgical drainage. Four patients were elderly, aged 69-80 yrs and were clinically in shock at the time of diagnosis. Seven of the eight patients survived.

Legionella pneumonia complicating Wegener's granulomatosis

We describe a previously healthy man who presented with features consistent with Wegener's granulomatosis. While undergoing investigation, he developed acute respiratory failure, thought to represent progression of his vasculitis. Open lung and sinus biopsies were performed to obtain the diagnosis. Vasculitis was confirmed on the paranasasl biopsy, and the lung biopsy showed pneumonia due to Legionella pneumophila, an association not previously reported in Wegener's granulomatosis. If immunosuppressive therapy had been started without making the diagnosis of Legionella pneumonia on lung biopsy, the patient might well have succumbed to the infection.

Nebuhaler or nebulizer for high dose bronchodilator therapy in chronic bronchitis: a comparison

We have compared the clinical efficacy of high dose terbutaline sulphate (10 mg four times daily) delivered by either a Nebuhaler or jet nebulizer in 13 patients with chronic bronchitis in a 2-week, open, crossover study. Both treatment regimens improved run-in symptom scores but no significant changes were recorded in peak flow and spirometry. Side-effects were more common with the Nebuhaler and more patients preferred the nebulizer. However, the Nebuhaler is an alternative therapeutic option for delivery of high doses of bronchodilators in patients with chronic bronchitis.

Ganglioglioma, a malignant tumor? Correlation with flow deoxyribonucleic acid cytometric analysis

This study describes the flow cytometric deoxyribonucleic acid (DNA) analysis of a resected ganglioglioma. The initial histopathological analysis revealed a benign tumor characterized by a predominance of mature ganglion cells. The flow cytometric DNA analysis of the necrotic areas, however, demonstrated an aneuploid population of cells. Further examination by histological analysis of the tumor revealed both benign and atypical foci. The retrospective DNA analysis performed from paraffin sections of tissue with benign-histological findings demonstrated euploid populations of cells consistent with a benign, slow-growing lesion. In contrast, DNA analysis performed from tissue with atypical histological findings revealed aneuploid populations of cells consistent with a malignant phenotype. Our analysis provides additional data supporting the existence of tumor progression in some gangliogliomas. Results support the concept of tumor cell heterogeneity and the importance of adequate tumor sampling. The finding of aneuploid populations with unfavorable histology further supports the use of flow cytometry as an adjunct method in assessing tumor biology.

MR evaluation of hydrocephalus

An analysis of sagittal T1-weighted MR studies was performed in 23 patients with hydrocephalus, 58 patients with atrophy, and 100 normal patients. The average mamillopontine distance was 1.15 cm for the normal group, 1.2 cm for patients with atrophy, and 7.5 mm for patients with hydrocephalus. A reduction of the mamillopontine distance below 1.0 cm was found in 22 patients with hydrocephalus, 5 patients with atrophy, and 15 normal patients. Dilatation of the anterior third ventricle was noted in 21 patients in the hydrocephalus group and in none of the patients in the atrophy and normal groups. The average thickness of the corpus callosum at the level of the foramen of Monro was 6 mm in normal subjects and was reduced below 6 mm in 16 of the hydrocephalus patients. Smooth elevation of the corpus callosum was noted in 20 hydrocephalus patients, in 2 patients with atrophy, and in none of the normal patients. MR improves the accuracy of diagnosis in patients with hydrocephalus both because of its ability to show small obstructing lesions that are not depicted by CT and because the mass effect of the distended supratentorial ventricles produces anatomic changes that are delineated with precision by MR.

Skin necrosis following Haemaccel

Haemaccel is a plasma substitute in frequent clinical use with a low incidence of side effects. I report a patient who developed necrotic blisters following two Haemaccel-insulin infusions, a previously undescribed complication. The rationale behind carrier solutions for insulin therapy is discussed and some of the problems associated with Haemaccel use are considered. I conclude by urging caution in the use of Haemaccel as a carrier solution for insulin therapy.

Intradural dermoid cyst. A case report

Intraspinal tumors must be included in the long list of differential diagnosis in the patient presenting with the low-back radicular pain syndrome. These tumors are classified easily by their relationship to the dura, and the type of compression readily discerned by myelography. Intradural dermoid cysts account for 1% of intraspinal tumor, but prompt, meticulous, surgical intervention may result in an excellent outcome.

Acute anterior spinal epidural abscess

We have reported a case of acute spinal epidural abscess, an uncommon cause of pain in the neck and back. The typical progression from spinal ache to paralysis may be halted if the diagnosis is suspected and prompt radiologic and surgical interventions are initiated.