Krypton-81m gas, by virtue of its imaging characteristics, is often considered the "gold standard" for ventilation scintigraphy but its use is restricted by its high cost and limited availability. The new radiopharmaceutical 99Tcm-Technegas, a suspension of ultrafine technetium-99m labelled carbon particles, produces high-quality images of ventilation and has the advantage of continuous availability. As part of our evaluation of Technegas the two were compared in 40 patients with a variety of established respiratory diseases. Disparities were seen in five patients in five diagnostic groups and may be a consequence of the differing physical properties of the two agents and the different inhalation techniques used. In addition two interesting features were noted on the Technegas images. (1) Hot spots were seen in 50% of patients, particularly in those with a degree of airways obstruction; (2) preferential basal deposition of activity was seen in 30%, particularly in patients with idiopathic pulmonary fibrosis. Both features were significantly associated with parameters of pulmonary function indicating obstructive lung disease in the former case and restrictive lung disease in the latter.
Four patients with severe bronchiectasis (chronic bronchial suppuration) are described who developed cutaneous lesions associated with exacerbations of their respiratory disease. The skin abnormalities consisted of purpuric lesions in three patients and an erythematous vasculitis in one. Circulating immune complexes were present in all patients and in three skin biopsy specimens showed deposition of C3, IgG, and IgA in dermal blood vessels. Haemophilus influenzae had been isolated from the sputum of all four patients and in two patients was present at the time the cutaneous lesions appeared. It is suggested that local immune complex deposition was responsible for the skin lesions which occurred during acute exacerbations of bronchiectasis.In recent years various immunological abnormalities have been reported in patients with chronic bronchial suppuration (severe bronchiectasis). These abnormalities have included an increased incidence of autoantibodies, raised immunoglobulin concentrations, and circulating immune complexes.'-3 In addition, many immunological diseases have been shown to be associated with severe bronchiectasisfor example, autoimmune thyroiditis, pernicious anaemia, rheumatoid arthritis, systemic lupus erythematosus, and ulcerative colitis.'4 6 In common with patients with other chronic pulmonary conditions, those with bronchiectasis have a high incidence of circulating immune complexes;' but there have been few reports of cutaneous lesions associated with this disease and in a review of 35 patients with cutaneous vasculitis8 only one had bronchiectasis.We report four patients with chronic bronchial suppuration who developed skin lesions of varying type and distribution in association with exacerbations of their respiratory symptoms. All had circulating immune complexes and in three patients there was histological evidence to suggest that local immune complex deposition may have mediated the cutaneous lesions.
Preterm labour continues to complicate a substantial number of pregnancies, and preterm delivery accounts for most early neonatal deaths not due to congenital abnormalities.' Ritodrine hydrochloride, a 13 sympathomimetic agent with predominant effects on 0 receptors such as those of the uterus,2 is effective in suppressing premature uterine contractions.2 We describe six pregnant women given ritodrine hydrochloride who developed swelling of the salivary glands with hypersecretion of amylase. Patients and resultsFrom May 1990 to October 1991 we treated 150 pregnant women with premature uterine contractions with ritodrine hydrochloride. The drug was administered intravenously in a solution containing 50 mg of ritodrine hydrochloride in 500 ml of 5% glucose. The solution was administered at a rate of 50 tg/min, increased by 50 tg/min every 20-30 minutes in response to continued uterine activity until tocolysis or toxicity occurred or a dose of 350 Ftg/min was reached.Of the 150 patients six developed symptoms of parotitis after the administration of ritodrine ( CommentSix pregnant women developed symptoms of parotitis several hours after the administration of ritodrine hydrochloride. Serological tests performed in five of them excluded the possibility of mumps infection.The clinical side effects of ritodrine reflect its 3 mimetic activity.2 To our knowledge, however, 13 mimetics have not been reported to have an effect on the salivary gland in humans, though Selye observed that another 3 mimetic agent, isoprenaline, induced hypertrophy of the salivary gland in rats.3 Following this observation the relation between adrenergic agents and salivary gland function was investigated in rats since hypertrophy of the salivary gland and hypersecretion of amylase occur via the stimulation of 13 adrenoceptors.4 In vitro experiments showed that human salivary gland tissues also secrete amylase in response to isoprenaline.5 The hypersecretion of amylase and the swelling of the salivary glands in our six patients therefore probably resulted from the administration of ritodrine hydrochloride. Clinicians should be aware of this adverse effect of ritodrine, which might also occur in women receiving other (32 agonists for the treatment of premature labour. Patients, methods, and results The study was approved by the local medical ethics committee. Twenty eight patients were randomly recruited (by random numbers sampling from full clinic list) from an outpatient respiratory clinic over six months with the following inclusion criteria: (a) spirometrically proved airways obstruction (a ratio of forced expiratory volume in one second (FEV1) to
Chronic bronchial suppuration has been associated with elevations in immunoglobulin levels, circulating autoantibodies and immune complexes but the cause is obscure. In order to investigate one possible explanation we studied eight male subjects (mean age 54.9 years, range 39-68) and 16 female subjects (mean age 45.2 years, range 24-68) with bronchial suppuration attributed to bronchiectasis. Gram-negative organisms were found in the sputum of 95% of subjects. Forty per cent (10 subjects) had elevations in immunoglobulin levels and 60% (15 subjects) had circulating autoantibodies. Eighty-eight per cent (21 subjects) had mild-moderate increases in the level of C-reactive protein. Endotoxin was detected using the limulus amoebocyte lysate test in 50% (12 subjects). Endotoxin was found only in patients with an immunological abnormality and was more likely to be detected in those with both elevated immunoglobulins and circulatory autoantibodies. It is suggested that the endotoxin may be of aetiological significance in the development of autoantibodies and elevations of immunoglobulin levels.
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