Detection of early pregnancy factor in swine: A need for dialogue

The rosette inhibition test, which has been used to detect early pregnancy factor (EPF) and other immunosuppressive factors in the serum of pregnant mice, women, and sheep, was adapted for use in swine. Since the initial methods described for use of the assay were cumbersome and time consuming, our first efforts were to simplify the technique. Substitution of microtiter plates for test tubes and treatment of sheep erythrocytes with AET to increase numbers and stability of the rosettes were successful. Although consistently higher rosette inhibition titers were obtained after incubation of lymphocytes in the serum of pregnant sows compared to controls, the variability in numbers of rosettes obtained on a day to day basis and the cumbersome nature of the test have impeded progress in firmly establishing the presence of EPF in pregnant swine and demonstrating the homology between it and the EPF reported in other species.

A systematic approach to the investigation and diagnosis of a unilateral pleural effusion

Fluid in the pleural space is a common sequela of a wide range of diseases which may be pulmonary, pleural or extrapulmonary. As the differential diagnosis is wide, a systematic approach to investigation and diagnosis is recommended. This review highlights the important features and recommendations for the investigation of a unilateral pleural effusion, a common condition encountered by the general physician. The aim of this study was to assist with a speedy diagnosis of the underlying pathology, using appropriate investigative techniques, while minimising the use of invasive procedures.

Guidelines on the diagnosis and treatment of pulmonary non-tuberculous mycobacteria infection

While the prevalence of Mycobacterium tuberculosis continues to decline in the developed world, the same cannot be said for non-tuberculous mycobacteria (NTM). These organisms are increasing in incidence and prevalence throughout the world. This is probably because of a combination of increased exposure, improved diagnostic methods and an increase in the prevalence of risk factors that predispose individuals to infection. Considerable confusion can arise in determining in the wide range of species whether an isolated NTM is in fact a contaminant or a pathogenic organism when isolated in sputum or bronchoalveolar lavage. This confusion combined with increasing requests for advice on the treatment of disease has led to the development of guidelines to assist the clinician in diagnosing and treating infection accurately.

Equivalent efficacy and safety of a new HFA-134a formulation of BDP compared with the conventional CFC in adult asthmatics

The present study demonstrates the equivalent efficacy for BDP 500 microg bid given via MDI with the new HFA-134a propellant (Chiesi Farmaceutici S.p.A., Parma) compared to a conventional CFC propellant (Becotide, Allen & Hanburys, UK). One hundred and sixteen adult patients with stable mild to moderate asthma (FEV1 > or = 60% of predicted normal) entered a 2-week run-in period where they maintained their own inhaled corticosteroids and were then assigned to a 12-week treatment with the test drug in a randomized, multicentre, double-blind, double-dummy, parallel-group design. Ninety-one patients completed the study period. Morning and evening peak expiratory flow rate (PEFR), use of rescue salbutamol, number of daytime and nighttime asthma attacks, number of nighttime awakenings, and clinical symptoms were recorded daily by patients on a diary card. Pulmonary function tests (FEV1, FVC, PEFR, MEF50 and FEF25) were completed at study entry, at the start of treatment and every 2 weeks thereafter. Morning (08.00-10.00 AM) serum cortisol was measured at the start and at the end of treatment. Adverse events were collected for the total study period. Equivalence between groups was demonstrated for the primary end-point morning PEFR, as well as for evening PEFR and FEV1 (the 95% CI of the treatments' difference was within the 5% of the LSM of BDP CFC). The other secondary pulmonary function tests measured at the clinic visit showed a satisfactory asthma control, albeit without statistically significant differences between groups. Decreases in the use of rescue salbutamol and in clinical symptoms were also reported in both groups, with no differences between them. Adverse events were reported in 81.4% of patients in the BDP HFA group and in 82.5% in the CFC group. There were 73 and 59 adverse drug reactions in the two groups, respectively; the difference was mainly due to differences in taste. No drug-related serious adverse events were reported in either group. No difference was seen for morning serum cortisol between baseline and end of treatment, or between groups. In conclusion, the BDP-HFA 134a formulation proved to be statistically equivalent to the standard BDP CFC product over 12 weeks in adult patients with mild to moderate asthma.

Eradication of house dust mite from homes of atopic asthmatic subjects: a double-blind trial

BACKGROUND

House dust mite (HDM) allergens can accumulate to very high levels in homes. From the observed sensitivity of HDMs to heat and their allergens to steam, a novel treatment of furnishings has been developed.

OBJECTIVE

We sought to determine whether combined steam and heat treatment of home furnishings reduced asthmatic patients' bronchial hyperreactivity (BHR) and lowered HDM antigen loads.

METHODS

The homes of 30 asthmatic subjects aged 18 to 45 years were randomly allocated into 3 groups. In groups 1 and 2 mattresses and duvets were treated with hot air (110 degrees C), followed by steam and then heat again. All their carpets were steam cleaned. Group 2 also had a special ventilation system installed above each patient's bedroom. The homes of subjects in group 3 were sham treated. Neither patient nor laboratory staff was aware of the types of treatment. Der p 1 and 2 levels in the household dust from the lounge, bedroom carpet, and beds were determined before and after treatment and then at 6 and 12 months. BHR, measured by using histamine PD(20) values, was recorded during the 4-week run-in period and at 3, 6, 9, 12 months after treatment.

RESULTS

Active heat-steam treatment of homes caused a sustained reduction of Der p 1 (P =.003) and Der p 2 (P =.001) compared with no change in sham-treated group 3 homes. Patients whose homes were treated showed a 4-fold reduction in BHR at 9 months in group 1 and throughout the posttreatment period in group 2. No change was observed in the asthmatic subjects whose homes were not treated. These improvements were sustained for 12 months in the homes with bedroom ventilation units.

CONCLUSIONS

A single treatment of home furnishings reduced mite allergen load to below the risk level for sensitization and improved the asthmatic patients' BHR by 4-fold.

Male and female differences in reports of women's heterosexual initiation and aggression

Previous work that compared male and female reports of women's heterosexual initiation and aggression is replicated. It was hypothesized that men's reports of women's sexual initiation and aggression would be significantly greater than women's self-report of sexual initiation and aggression in the most recent sample. Of the 24 questionnaire items, 12 of the 17 specifically designed to assess sexual initiation or aggression demonstrated significant reporting differences. For every questionnaire item, except "mutually consenting contact," men reported women initiating sexual contact more often than women self-reported. In addition, comparisons were made to determine the level of agreement between the results of this study and a previous study in which the same comparisons were made with a different sample. It was hypothesized that the identical questionnaire items would demonstrate significant gender-based reporting differences in both samples. This hypothesis was mostly supported with 11 items showing a significant difference in both samples. In both samples, males reported receiving female initiation and aggression more frequently than females reported giving. Logistic regression results supported a difference in perception of women's sexual initiation based on gender of respondent. In both samples men see women's initiation as less conforming to traditional social norms for women and more aggressive than women do. Gender role expectations and social desirability may influence male and female perceptions of female heterosexual initiation and aggression in a way that contributes to significant differences in reporting.

Postural changes of the cervical spine in patients with nontoxic goiter

PURPOSE

To investigate differences in cervical spine posture and range of motion and self-reported neck pain and headache between patients with nontoxic goiter compared with a matched control group.

DESIGN

An observational, controlled, blinded study.

SETTING

The ambulatory outpatient facility of a university hospital.

PARTICIPANTS

Twenty-five nontoxic goiter patients and 25 matched nongoiterous control subjects from the Department of Endocrinology.

INTERVENTION

Participants were X-rayed from a lateral position in neutral, full flexion and full extension, and the radiographs were evaluated by a blinded examiner for anterior head carriage, maximal flexion, maximal extension and the extent and severity of any degenerative changes in the cervical spine. The degree of postural neck muscle tenderness was evaluated by a blinded rheumatologist using a validated Total Tenderness Score system. In addition, the two groups were compared for their self-reported frequency of neck pain and headaches.

RESULTS

A significant increase in anterior head carriage was found among the goiter patients (p = .01), together with a corresponding decrease in flexion (p = .01), whereas the corresponding increase in extension was not statistically significant (p = .16). A higher prevalence of headaches was found in the goiter group (p = .06), but there was no difference in neck muscle tenderness (p = .40) or frequency of neck problems (p = .40) between the groups. The severity of degenerative changes in the cervical spine (p = .22) and the number of vertebral levels with degenerative changes (p = .13) were similar in the two groups.

CONCLUSIONS

Goiters of > 100 g seem to alter the posture of the cervical spine, possibly resulting in a tendency for more frequent headaches. The changes do not seem to cause more neck pain, muscle tenderness or degeneration of the cervical spine.

The emergency medical services system response to a commercial airliner incident at the very remote location of Shemya, Alaska

INTRODUCTION

A multiple patient incident involving a commercial airliner is a challenge for any community EMS system. When the community is on a remote island in the North Pacific Ocean, where there is no hospital and only a small clinic staffed by just one physician and several nurses and technicians, the challenge is much greater. The incident described herein necessitated providing emergency care at the airport, and at the same time, activating a response capability from hundreds of miles away to transport the patients to definitive care. The situation was compounded further by the fact that most of those injured spoke little or no English. This paper reviews the events that occurred and the lessons learned.

OBJECTIVE

To identify the events that occurred when a commercial airliner, with more than 250 passengers and crew aboard, experienced an in-flight "upset" that resulted in many being injured. What was learned may help other areas be better prepared for such events.

STUDY POPULATION

A commercial airliner incident that occurred in April, 1993 resulted in the need for emergency medical care at the remote island location of Shemya, Alaska initially, and fixed-wing transport of the injured to definitive care in Anchorage, Alaska, USA, which is about 1,300 miles (2,130 km) from Shemya.

METHODS

A case review methodology was used that included interviews with key persons involved in the response to this incident to learn first-hand what occurred; by review of the National Transportation Safety Board (NTSB), reports, and by having agencies involved in the event review draft report materials to ensure accuracy.

RESULTS

This study showed how a remote site with a small cadre of medically trained personnel could organize and effectively provide initial emergency care for > 200 persons, and have them transported more than a thousand miles to definitive care.

CONCLUSIONS

Valuable lessons were learned from this incident that may help other areas be better prepared, particularly in remote areas, for large multiple patient events.

College students' high-risk sexual behavior following alcohol consumption

This study is a follow-up to a previous study assessing the relationship of alcohol consumption as a disinhibitor to high-risk sexual behavior. Results are based on survey data from 1,902 students attending 12 colleges. Sexual behaviors occurring after people had "let themselves drink more than normal in order to make it easier for them to have sex with someone" were assessed. At least once in the past year, 33.2% of the men and 17.4% of the women had met this criterion. In those instances, 76.3% of the men and 77.1% of the women initiated condom use for vaginal intercourse. Results are discussed in relation to partners' compliance following condom initiation and preventing the spread of HIV disease.

A comparative analysis of the emergency medical services and rescue responses to eight airliner crashes in the United States, 1987-1991

INTRODUCTION

Crashes involving commercial airliners stress emergency medical services (EMS) and rescue operations to performance far in excess of everyday activities, and special adaptations of everyday responses need to be implemented. Fortunately, these events are infrequent and usually do not occur more than once in any location. The responses that occur must be highly coordinated and efficient. Little is known about the responses to such events. This study examines the EMS and rescue responses associated with eight recent crashes involving commercial airliners in the United States.

OBJECTIVE

To identify common factors for which alterations in responses may enhance the survival and decrease the morbidity to victims involved in commercial aviation crashes.

STUDY POPULATION

Eight commercial airliner crashes in the United States from 1987 through 1991.

METHODS

Case review using: 1) press and media accounts; 2) U.S. National Transportation and Safety Board testimony and reports; and 3) structured interviews with airport, fire, EMS, and hospital personnel. Data were collated and common factors identified for the cases. Findings are classified into: 1) conditions at the crash sites; 2) initial responses; 3) scene management; 4) scene status; 5) patient transport; 6) hospital responses; and 7) preplanning exercises.

RESULTS

Common factors that impaired responses for which some remediation is possible include: 1) new methods for training including computerized simulations; 2) improvements in rescue-extrication equipment and supplies; 3) stored caches of EMS equipment and supplies at airports; 4) ambulance transport capabilities; and 5) augmentation of patient transport capabilities.

CONCLUSIONS

Many lessons can be learned through structured studies of commercial aircraft crashes. These findings suggest that simple and relatively inexpensive modifications may enhance all levels of emergency responses to such events.

Spirituality and sexuality: The healthy connection

This article offers an appraisal of the relationship between the spiritual and sexual dimensions of our health. It is argued that the essential ingredient of connectedness is at the core of each of these two dimensions. A framework of seven dimensions of health is presented as a paradigm for discussing this relationship. Finally, the personal and professional implications of expanding and promoting the spiritual and sexual aspects of our health, and the striking connection between them, are discussed.

Superior vena caval obstruction managed by the Gianturco Z Stent

Twenty patients with superior vena caval obstruction (SVCO) due to malignancy were managed using the Gianturco Z Stent. Three patients had adjunctive thrombolysis. The primary clinical success was 90% (18/20 patients). Thirteen patients were free of SVCO to death or follow-up without re-intervention (primary patency = 65%). Three patients had re-intervention for recurrent symptoms, two successfully (secondary long-term patency = 75%). Stenting of the SVC is a valuable, under-used technique for the symptomatic relief of superior vena caval obstruction.

Reports of female initiation of sexual contact: male and female differences

Women's reports of initiating sexual contact and men's reports of experiencing female initiation were compared. 128 male and 212 female college students were recruited from sexuality classes at three institutions. It was hypothesized that there would be no significant difference between women's reports of initiating sexual contact and men's reports of experiencing female initiation. A chi-square test of significance at the p < 0.05 level with an alpha rate adjustment (p < 0.002) using the Bonferroni technique was implemented. Of 26 questionnaire items, 15 registered significant differences between male and female reports (p < 0.002). Overall, males reported experiencing female initiation more frequently than females reported initiating. Traditional gender roles may influence male and female perceptions of female initiation of sexual contact in a way that contributes to significant differences in reporting.

The relationship of semen quality to pregnancy rate and litter size following artificial insemination in the bitch

Artificial insemination of 31 bitches with fresh, undiluted, semen resulted in 22 31 conceptions (71%) and the birth of 124 puppies. Inseminations using at least 220 x 10(6) spermatozoa of normal morphology resulted in a mean pregnancy rate of 81.5% (22 27 ). The pregnancy rates were significantly influenced by the total number of progressively motile or morphologically normal sperm cells per ejaculate (P < 0.05). The pregnancy rate was not influenced by the percentage of progressively motile or morphologically normal sperm cells per ejaculate (P > 0.1). Litter size was not influenced by sperm motility or morphology (P > 0.1).

Suitability of and tolerance to Iotrolan 300 in bronchography via the fibreoptic bronchoscope

The contrast agent Iotrolan 300 has potential advantages for bronchography over previous agents in that it can be injected directly through the bronchoscope and it does not obscure bronchoscopic vision or interfere with further bronchoscopic procedures. It was used for selective bronchography in 20 patients with suspected bronchiectasis. Side effects and change in FEV1 and in arterial oxygen saturation were compared in these patients and in 14 patients undergoing bronchoscopy for suspected carcinoma. Thirteen of the 20 patients undergoing bronchography had side effects, mainly headache, nausea, and a feeling of heat or flushing. The fall in FEV1 at four hours (0.3 l) did not differ from the fall in the control group (0.1 l). The fall in arterial oxygen saturation (SaO2) during bronchography (9.4%) did not differ significantly from the fall during bronchoscopy in the control group (6.1%). Iotrolan gave good quality bronchograms, which in all cases provided a diagnosis. Iotrolan appears to be suitable for bronchography by fibreoptic bronchoscope and to be well tolerated.

Is EMS communicating with the FCC?

Radio communication problems in EMS run the spectrum from annoying to deadly. Dedicated radio frequencies for EMS, much like those exclusive to police and fire departments, are long overdue.

Survey of the prevalence and types of infertility in beef cows and heifers

Thirty to 180 days after natural mating to bulls, 8,184 beef cows and heifers were palpated rectally for pregnancy determination. Of these, 7,396 (90%) were pregnant and 815 (10%) were not pregnant. Regarding the nonpregnant cattle, 315 (38.7%) had a normal uterus and a functional corpus luteum, suggesting that they were cycling; the rest had palpable pathologic findings: 455 (55.8%) had ovarian inactivity and uterine atrophy; 16 (2%) had pyometra; 12 (1.5%) had a mummified fetus; 7 (0.9%) had chronic metritis; 6 (0.8%) had an involuting uterus; and 4 (0.5%) had adhesions of the uterus, ovaries, or a combination of both. For the purpose of comparison, the cattle were grouped according to age: group 1-1,035 nulliparous heifers 18 to 24 months of age; group 2-1,137 primiparous heifers 30 to 36 months of age; group 3-5,548 multiparous cows between 4 and 9 years of age; and group 4-464 cows 9 years of age or older. The pregnancy rates were 79.1, 72.2, 96.8, and 78.2, respectively, for these groups. The pregnancy rate for 4- to 9-year-old cows was significantly greater (P less than 0.05) than that for the other age groups.

Prevalence of postservice pyometra in a herd of beef cows infected with trichomoniasis: A case report

Trichomoniasis was detected in a herd of beef cows during a routine yearly reproductive examination. The examination revealed that 12.6% of the cows (75 597 ) were not pregnant. Of these, 65.3% (49 75 ) had a normal uterus and a functional corpus luteum, suggesting that they were cyclic; 21.3% (16 75 ) had pyometra; 6.7% had inactive ovaries and uterine atrophy and were not cyclic; 4% (3 75 ) had an involuting uterus, suggestive of a recent abortion; and 2.7% (2 75 ) had a mummified fetus. The herd had been on a reproductive herd health program for the past 10 years and had averaged 92-99% pregnant cows during this time. Pyometra was diagnosed by rectal palpation, and trichomonads were detected in the pyometra exudate.

Mechanisms and therapy for retained fetal membranes and uterine infections of cows: A review

Literature pertaining to retained fetal membranes and postpartum uterine infections of cows was reviewed. Many therapeutic failures are explained by the effects of the uterine environment on antibacterials, the effects of therapy on the uterine defense mechanism, bacterial resistance patterns and the failure to recognize normal physiological processes in the postpartum period. Prostaglandin F(2)alpha and its analogues provide effective alternatives to antibiotic and antibacterial therapy for most postpartum disorders.

Early invasive carcinoma in colonic polyps. A review of the literature with emphasis on the assessment of the risk of metastasis

The proper treatment of adenomatous colonic polyps containing small foci of invasive cancer is controversial because the metastatic potential of these lesions is not precisely known. This article critically reviews all known English language studies of this lesion. Before the introduction of colonoscopic polypectomy, the estimated incidence of metastasis from this lesion was 10.4% (based on 12 studies containing 347 polyps), with a confidence interval (95% level) of 7.4 to 14.1. The incidence of metastasis estimated from lesions removed via colonoscopic polypectomy was 10.1% (based on 13 studies containing 188 polyps), with a confidence interval of 5.9 to 14.8. Differences in the definitions of the involved lesions, study designs, and indications for resection cause problems with case selection bias and make comparison of studies difficult. These problems are discussed in detail. Most studies had broad confidence intervals for the estimated incidence of metastasis because of small sample size. The histopathologic criteria, as reflected in the literature, for considering polypectomy alone as adequate treatment for this lesion are summarized and discussed.

Early invasive carcinoma in colonic polyps. A review of the literature with emphasis on the assessment of the risk of metastasis

The proper treatment of adenomatous colonic polyps containing small foci of invasive cancer is controversial because the metastatic potential of these lesions is not precisely known. This article critically reviews all known English language studies of this lesion. Before the introduction of colonoscopic polypectomy, the estimated incidence of metastasis from this lesion was 10.4% (based on 12 studies containing 347 polyps), with a confidence interval (95% level) of 7.4 to 14.1. The incidence of metastasis estimated from lesions removed via colonoscopic polypectomy was 10.1% (based on 13 studies containing 188 polyps), with a confidence interval of 5.9 to 14.8. Differences in the definitions of the involved lesions, study designs, and indications for resection cause problems with case selection bias and make comparison of studies difficult. These problems are discussed in detail. Most studies had broad confidence intervals for the estimated incidence of metastasis because of small sample size. The histopathologic criteria, as reflected in the literature, for considering polypectomy alone as adequate treatment for this lesion are summarized and discussed.

An "unavoidable" death in a people's marathon

With the increase in jogging and distance running as a means of attaining and maintaining fitness, and in the light of the difficulty in advising certain groups of patients about their capacity for such exercise, we report on several potentially avoidable factors in the death of a 45 year old Sheffield Marathon runner in June 1983.

Comparison of salbutamol given by intermittent positive-pressure breathing and pressure-packed aerosol in chronic asthma

A double-blind crossover study was performed to compare 4 . 8 mg salbutamol given by pressure-packed aerosol and intermittent positive-pressure breathing nebulization in chronic asthmatic patients. The two delivery techniques produced similar changes in respiratory function and pulse rates. Given equal effect, a high-dose pressure-packed aerosol would have advantages in cost and convenience over nebulization techniques.

Lipid environments in the yolk lipoprotein system. A spin-labeling study of the lipovitellin/phosvitin complex from Xenopus laevis

Lipid/protein and lipid/lipid interactions in the yolk lipoprotein complex from Xenopus laevis were examined by introducing a series of lipid spin-labels into the complex and observing the electron spin resonance spectra as a function of the position of the label along the lipid chains, temperature, pH, and charge on the lipid polar head group. Analyses of the spectra show that, in addition to the expected component arising from lipid associated with protein, a second component with increased segmental flexibility and the greater temperature dependence characteristic of lipid/lipid interactions is observed. These spin-labeling data and supporting compositional data indicate that much of the lipid is organized into a lipid-rich region or pool, consistent with the earlier model derived from electron microscopy and diffraction data and with companion 31P and 2H nuclear magnetic resonance data reported in the preceding paper [Banaszak, L. J., & Seelig, J. (1982) Biochemistry (preceding paper in this issue)]. The bilayer-like component exhibits a greater restriction of motion compared to vesicles of the isolated lipids at the same temperature, as would be expected for a relatively small lipid pool. Phospholipids exchange between the two motionally distinguishable environments. The equilibrium binding undergoes a shift between these two environments as a function both of pH and of the charge on the phospholipid polar head group. This shift in average binding affinity is opposite in direction to that reported for membrane proteins and implicates negatively charged groups on the protein that repel negatively charged phospholipids. This effect is greatly reduced by alkaline phosphatase treatment, suggesting that some of the lipid binding sites are in close proximity to phosphorylated residues on the protein.

Intrahepatic hematoma after aspiration liver biopsy. A prospective randomized trial using two different needles

The purpose of this study was twofold: (1) to determine the incidence of intrahepatic hematoma after liver biopsy by the aspiration technique and (2) to compare the incidence of hematoma after biopsy with a needle of 1.6 mm vs 1.9 mm OD. Fifty-one patients were randomly assigned to be biopsied with the smaller needle and 46 with the larger. Hematomas, diagnosed by development of characteristic transient defects on liver scans done shortly after biopsy, occurred in two (4%) of those biopsied with the smaller needle and in none of those biopsied with the larger. This difference is not statistically significant. Neither patient who developed a hematoma had changes in vital signs, CBC, or serum alkaline phosphatase. One had a fivefold rise in SGOT; n the other, the SGOT remained normal. If these results are considered with those of other prospective trials of similar design, the overall incidence of intrahepatic hematoma after aspiration biopsy may be estimated to be 2.3% when needles of 1.6-2.0 mm (OD) are used. Many of these go undetected because, justifiably, scans are not routinely done shortly after biopsies.

Familial Schmidt's syndrome

Among the 17 offspring of a common father, overt adrenal and thyroid insufficiency developed in three brothers. In eight of the 12 siblings then examined, and also in one of the two mothers of this kindred, endocrine abnormalities were documented. Early compensated adrenal and thyroid hypofunction with organ-specific antibodies were found in asymptomatic relatives. Pernicious anemia, vitiligo, and alopecia were also seen. Age of clinical onset varied from 18 to 38 years. Familial investigations may identify asymptomatic persons at risk for the development of serious endocrine deficiencies.

Combined therapy with salbutamol and beclomethasone inhalers in chronic asthma

A double-blind cross-over trial was carried out to compare the effect of identical placebo with that of salbutamol inhalers used 30 min before inhalation of 100 microgram of beclomethasone dipropionate (B.D.P.) in 18 chronic asthmatics over two consecutive 4-week periods. The salbutamol and B.D.P. combination resulted in a significant improvement in the peak expiratory flow-rate and F.E.V.1, significantly less use of the rescue inhaler, and better control.

Lignocaine aerosol and persistent cough

Four patients with intractable cough improved for periods of between one and six weeks after treatment with 400 mg of lignocaine by aerosol spray. Suprisingly the lignocaine increased airways resistance in some of them. It is suggested that the excessive cough is due to excessive sensitivity of tracheal cough or irritant receptors, secondary to mucosal damage. The dangers of lignocaine inhalation are referred to.