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Aim: To determine the validity of the diagnosis of chronic obstructive pulmonary disease (COPD) in general practice in patients given a diagnosis of COPD and treated with bronchodilators., Methods: From the medical records of eight Health Centres in Northern Greece, 319 subjects aged over 40 years and diagnosed as "COPD" were entered into the study. All filled in a special questionnaire and were subjected to spirometry, rhinomanometry and chest X-ray., Results: One hundred and sixty patients (50.2%) met the GOLD criteria for COPD. Twenty-six of them were non-smokers and underwent further evaluation: blood eosinophil count, serum IgE assay, high resolution computed tomography (HRCT) scan of the chest, and echocardiography; 16 were given a different diagnosis. One hundred and fifty-nine subjects (49.8%) with an FEV1/ FVC ratio >0.7 did not meet the GOLD criteria for COPD; 71 suffered from nasal obstruction, 13 from asthma, six had restrictive pulmonary disease and 69 had no respiratory disease., Conclusion: Diagnostic errors in patients with respiratory symptoms in the primary healthcare setting are frequent. Patients suspected to have COPD should undergo spirometry testing after bronchodilation. An alternative diagnosis must be sought for non-smoking patients with irreversible airway obstruction.

Clinical isolates of Escherichia coli sensitive and resistant to penicillin were compared in lipid composition and 14C-labelled penicillin uptake, as possible factors in resistance. Except for a slight increase in the triglyceride fraction in sensitive strains there were no qualitative or quantitative differences in the classes of extractable lipids present. Gas-liquid chromatography of the phospholipid and triglyceride fatty acids of the polar and non-polar fatty acids of the bound lipids showed that the same kinds of fatty acids were present. There was an increase of myristate in the chloroform-methanol extractable lipids of highly resistant strains accompanied by a rather general decrease of other fatty acids. Gas-chromatographic analysis of the polar-bound lipids showed an increase of the beta-hydroxydecanoic acid in the resistant strains. By studying the uptake of 14C-labelled benzylpenicillin and the crypticity of the beta-lactamase, evidence has been produced that a decreased permeability of resistant strains to penicillin cooperates with beta-lactamase to induce a high level of resistance. The altered lipid metabolism may reflect the special architectural changes in the cell wall which cause decreased permeability.