[A case of lithium intoxication at therapeutic lithium dosage due to additional diuretic therapy (author's transl)]

A case is presented of lithium intoxication with therapeutic doses of lithium, owing to the additional administration of a sodium-excreting diuretic. Since the patient was receiving neuroleptic therapy at the same time, intoxication symptoms at the onset were falsely attributed to neuroleptic extrapyramidal effects. The possible effects of widely-used diuretics in conjunction with lithium therapy are presented. The combination of both therapeutic substances is possible, but calls for extreme caution and strict control of medication, diet and serum lithium levels.

[Indications for central veinous catheterism in psychiatric patients (author's transl)]

Based on cases of a Psychiatric Intensive Care Unit specific indications and applications of catheterism of central-veins in these special instances are presented, the psychiatric indications and contraindications for such measures are submitted in addition to those known from other medical fields. The mode of insertion, duration, infusionregimen and rates of complications are reviewed in 102 cases. Two of the common veinous-catheter systems are compared as for practicability.

Treatment of severe attacks of asthma in children with nebulized B2 adrenergic agents

Selective B2 adrenergic agents given by nebulizer is described as a hospital or office treatment for severe attacks of asthma. Salbutamol and Bronkosol are shown to be effective and safe drugs. The method is a simple alternative to IPPB and is easier to use in small children. The use of long-acting, selective B2 adrenergic drugs by nebulizer is recommended in preference to non-selective and short-acting adrenergic agents like epinephrine and isoproterenol.

[The place of the subclavian catheter in the treatment of severe psychotic patients (author's transl)]

The insertion of a central venous catheter in the treatment of psychiatric patients is discussed on the basis of the therapeutic results obtained in 102 cases admitted to a psychiatric intensive care unit. Psychiatric indications and contraindications are now added to the known general indications and contraindications under other circumstances. Hypercaloric solutions, insertion technique into the subclavian and external jugular veins, duration of catether-aided nutrition and incidence of complications are discussed. The groups of psychiatric patients in whom the diagnosis is likely to lead to catheterization are defined. Two well-known catheter systems are discussed.

[Orally-administered taurine in therapy-resistant epilepsy (author's transl)]

The anticonvulsive action of taurine, was tested in 9 therapy in 9 therapy-resistant patients with a high incidence of seizures. Taurine was given orally (1.5-7.5 g daily) over a period of 4 to 16 weeks and, despite the high dosage, no appreciable side effects were observed. During this time seizures disappeared temporarily for about two weeks in 5 out of 9 cases. In one case the seizure frequency was transiently reduced by approximately 25%, whilst in the remaining 3 cases no effect of taurine on seizure frequency was observed. The reason for the rapid disappearance of the anticonvulsive action of taurine is not known.

Inhibition of exercise-induced asthma by different pharmacological pathways

Exercise-induced asthma (EIA) was provoked by standardized treadmill running for 6 minutes in 15 asthmatic children. The tests were carried out after the administration of a placebo, salbutamol, sodium cromoglycate, choline theophyllinate, and atrophine methonitrate aerosol in randomized fashion on different days. The mean post-exercise percent fall in peak expiratory flow rate was 45-2, 4-1, 19-6, 18-3, and 24-9 respectively. The proportion of children having significant amelioration of their EIA compared with those taking the placebo was 100% for salbutamol, 80% for cromoglycate and theophyllinate, and 60% for atropine. Salbutamol, choline theophyllinate, and atropine were bronchodilators at rest whereas cromoglycate was not, and the ability to suppress EIA was unrelated to bronchodilator effect. Even after bronchodilatation at rest, further broncho-dilatation occurred during the exercise period.

Suppression of exercise-induced asthma by salbutamol, theophylline, atropine, cromolyn, and placebo in a group of asthmatic children

A number of drugs are known to inhibit exercise-induced asthma (EIA), but the results in some cases have been difficult to interpret due to the techniques employed. A comparative study was carried out in a group of children to investigate the effects of salbutamol, choline theophyllinate, cromolyn sodium, atropine, and placebo. The exercise test took the form of six minutes of standardized treadmill running. All the drugs, but not the placebo, were able to inhibit EIA ti a significant degree, the effect being most marked with salbutamol. Cromolyn sodium caused no bronchodilatation at rest, while all the other drugs were brondhocilators, the effect being most marked with the atropine during exercise. It was impossible to distinguish the type of drug used for inhibition of EIA if it caused bronchodilatation at rest. The manner in which an exercise test can be used to investigate the duration of action or site of action of drugs is noted.

Exercise-induced bronchial lability in wheezy children and their families

Studies have been caried out to investigate bronchial lability as assessed by means of standardized running exercise tests. It was found that children who had been wheezy as infants had an abnormal degree of bronchial lability, even if they were asymptomatic, and closely resembled children who had continued to wheeze. The relatives of asthmatic children displayed a high incidence of bronchial lability, atopic diseases, and positive skin tests, and a similar incidence was found in the relatives of babies with wheezy bronchitis. The difference from a control population was particularly noticeable in the healthy relatives of wheezy children. Studies in monozygotic twins have shown a very high incidence of concordance for asthma, particularly when bronchial lability is taken into account. These studies suggest a common genetic basis for wheezing in childhood, based on the inheritance of bronchial lability. The difference in responses of the actively asthmatic subject from that of other labile subjects suggests that additional environmental factors are necessary to interact with the inherited bronchial lability.

The place of cromolyn sodium in the long-term management of childhood asthma based on a 3- to 5-year follow-up

The long-term value of cromolyn sodium in the management of childhood asthma has been assessed over 3 to 5 years in 46 children with chronic perennial asthma who were not initially receiving corticosteroid therapy. The need to use steroids because of poor control during treatment with SCG was taken as a criterion of SCG treatment failure. Most such failures occurred early, but there were a few late treatment failures so that the proportion of SCG successes leveled of at 65% by the fourth and fifth years. Failure with SCG tended to occur in the younger children whose disease had progressed rapidly. By the fifth year, half of the children successfully treated by SCG had been able to discontinue use of the drug, and these children, but not the others, had diminished bronchial lability as shown on exercise testing.

Exercise-induced asthma

A review of exercise-induced asthma is presented which describes work that has been carried out by the authors and by other investigators over recent years. The effect of exericse on lung function in asthmatic and normal subjects is compared. The influence of the type and severity of exercise on the response of the asthmatic is noted and the importance this has for interpretation of results. The effects of various drugs on exercise-induced asthma are considered in some detail. The clinical implications of the results of exercise tests in asthmatics, their relatives, and other subjects are considered in terms of the diagnosis and prognosis of asthma and its mode of inheritance. It is concluded that there is as yet no explantation for the mechanism of exercise-induced asthma, but it is a tool of potentially great value for research into the physiology and treatment of clinical asthma.

Treatment of childhood asthma for 13 months and longer with beclomethasone dipropionate aerosol

Twenty-six children with asthma were treated with beclomethasone dipropionate aerosol in a dose adjusted to their symptoms for 13 to 20 months. 18 children in the group had been taking systemic steroids at the start of the trial and all were successfully weaned off them, mostly within 2 months. All but 1 of the children were satisfactorily controlled by beclomethasone, but 15 children needed short courses of oral steroids at times of severe exacerbations. There was no evidence of either suppression or acceleration of growth, nor was there any adrenal suppression as assessed at intervals by the estimation of the resting level of plasma cortisol and the response to tetracosactrin. No other side effects were encountered apart from exacerbations of eczema or rhinitis in some children previously on systemic steroids.

Relationship between plasma cortisol and peak expiratory flow rat in exercise-induced asthma and the effect of sodium cromoglycate

1. The changes in peak expiratory flow rate (PEF) and plasma cortisol were studied in relation to a 6 min period of treadmill running in six normal and eighteen asthmatic subjects. Of the asthmatics patients, five were not receiving treatment with steroids, six were receiving low doses of steroids (under 7·5 mg of prednisone daily) and seven were receiving high doses of steroids (over 7·5 mg of prednisone daily) at the time of study.

2. All subjects were studied twice within 1 week at similar times of day, once after premedication with sodium cromoglycate (SCG) and once after a placebo.

3. Resting PEF and plasma cortisol did not differ between placebo and SCG tests.

4. No change in PEF occurred as a result of exercise in the control subjects. The asthmatic patients developed post-exercise bronchoconstriction which was partly prevented by SCG but was not affected by steroids.

5. Plasma cortisol rose after exercise in the asthmatic subjects but not in the control subjects. The rise may have been related to the stress of exercise-induced asthma. SCG had no significant effect on plasma cortisol after exercise.

Beclomethasone aerosol in childhood asthma

Twenty children have been treated with the steroid aerosol beclomethasone, half of them in an open trial and the other half in a controlled cross-over trial. Children were assessed by means of clinical examination, diary records, and twice-daily peak flow rate measurements made at home. After 1 to 2 months all but 1 of the 16 children who were initially taking systemic steroids or corticotrophin were weaned off these drugs. The cross-over trial showed a significant improvement on the active drug, in terms of diary score, bronchodilator use, steroid dose, and twice-daily peak expiratory flow measurements. Adrenal function was entirely normal after 1 and 3 months on the drug as measured by morning cortisol levels and the response to tetracosactrin. There were no side effects, apart from the reappearance of hay fever or eczema in some children previously on systemic steroids. Follow-up for a mean of 4·5 ± 2·2 (SD) months showed the continuing efficacy of beclomethasone, though an increase in dose has been needed in some children. The advantages of aerosol steroid therapy in children are noted.

Exercise-induced bronchial lability in children with a history of wheezy bronchitis

Exercise tests were carried out on 18 children who had had wheezy bronchitis under the age of 5 years during hospitalization 7 years previously. A control group of 12 children who had been hospitalized with gastroenteritis at the same time were also studied. It was found that there was still a significant increase in bronchial lability among the wheezy bronchitis group compared with the controls, and this was especially obvious in the 7 children who had continued to have mild episodes of wheezing. It is suggested that the same abnormal mechanism operates in at least some cases of wheezy bronchitis as it does in asthma.