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, , 110-114. The levels of amoxycillin in sputum, saliva, and serum from 22 patients were estimated. Fifteen patients had pneumonia and seven had acute exacerbations of chronic bronchitis. The drug was given orally in a dose of 500 mg four times daily. There was considerable variation in the levels in specimens from different patients. The mean sputum levels two to three hours and six hours after the dose were 0·52 and 0·53 μg/ml respectively. The mean two-hour saliva level was 0·32 μg/ml. The mean serum levels two and six hours after the test dose were 11·0 and 3·5 μg/ml respectively. The higher levels of amoxycillin were usually associated with the presence of more pus in the sputum. The mean levels of amoxycillin at comparable times were significantly greater than those found in a previous study after the same dose of ampicillin. Clinical response to treatment occurred more rapidly in those patients with sputum levels of 0·25 μg amoxycillin per ml or above than in those with lower levels. The time taken to clear potential pathogens from the sputum was related to the pathogen rather than to the amoxycillin level, persisting for longer than [ABSTRACT FROM PUBLISHER]

Four cases of poisoning by nitrous fumes are reported. Three patients presented with pulmonary oedema, and one of these progressed to the phase of bronchiolitis obliterans; the fourth patient presented with the clinical features of bronchiolitis obliterans. Pulmonary function studies in both phases showed a predominantly restrictive pattern of ventilatory abnormality with a tendency to hypoxaemia, hypocapnia, and reduced transfer factor. Complete recovery followed prompt treatment with corticosteroids. It is emphasized that three of these four accidents were preventable. [ABSTRACT FROM PUBLISHER]

Sulphasalazine is a drug which is widely used in the treatment of ulcerative colitis. Although a high incidence of side effects has been reported, pulmonary complications of treatment have not been described previously. The clinical, haematological, and radiological abnormalities which occurred in one patient two months after sulphasalazine was started are described. Withdrawal of treatment was followed by recovery; reintroduction of the drug caused a relapse associated with eosinophilia and impaired pulmonary function. We suggest that the possibility of drug-induced lung disease should be considered in any patient who develops symptoms or radiographic evidence of pulmonary disease while receiving treatment with sulphasalazine. [ABSTRACT FROM PUBLISHER]

Chemical pleurodesis using iodized talc is an effective method of treating symptomatic recurrent malignant pleural effusions. Twenty-three effusions occurring in 21 patients treated by this method are described with two illustrative case reports. The procedure eliminated the need for further chest aspiration in all but one instance. The histological appearances of the pleura at intervals after pleurodesis are also described. [ABSTRACT FROM PUBLISHER]

Introduction Manual muscle testing, in the form of the Medical Research Council sumscore (MRC-SS) is a widely accepted clinical tool for diagnosing intensive care unit-acquired weakness (ICU-AW). Although MRC-SS is a simple bedside test, the nature of the test is volitional limiting its ability to distinguish poor motivation and impaired cognition from actual loss of muscle function. The clinical predictive value of the MRC-SS therefore needs to be assessed. Method Unselected adult ICU patients (=18 years) ventilated for =48 h were eligible. The conscious level of the patients was determined using the Richmond Agitation Sedation Scale; a score -1 to +1 was indicative of awakening. Testing comprised of a two-stage process. Stage 1: Patients at awakening were required to follow 4 simple, one-stage commands. Stage 2: If all 4 one-stage commands were successfully completed, MRC-SS testing was performed by a specialist ICU rehabilitation clinician. ICU-AW was defined as MRC-SS <48. ICU and hospital mortality and length of stay (LOS) were recorded in all the patients. Results 94 sequential awakening patients were recruited; 68.1% males (n=64), with a mean age for the whole cohort of 64.5±15.3 years. 29 patients were unable to successfully complete the 4 one-stage commands as a result of cognitive impairment. 65 patients completed the MRC-SS of whom 73.9% demonstrated ICU-AW at awakening. Results are shown in Abstract P67 table 1. Conclusion Almost a third of critically ill patients, from a sequential cohort, were unable to complete 4 one-stage commands and thus could not perform the MRC-SS. Although inability to successfully complete the one-stage commands conferred limited predictive value, those patients that could perform this task were more likely to survive ICU. Similarly an MRC-SS <48 at awakening, presumed indicative of ICU-AW, conferred limited predictive value. However an MRC-SS =48 predicted ICU and hospital survival as well as an ICU LOS <2 weeks. These data highlight the limitations of volitional tests in critically ill patients. It clearly challenges the current view that ICU-AW, as measured by volitional tests, is a predictor of poor outcome. These data confirm that preserved peripheral strength predicts a good outcome. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about mycobacterial infection published in the January 2001 issue of the journal "Thorax."