No abstract

The effect of sauna on tracheobronchial clearance was studied in five male patients with chronic bronchitis by a radioaerosol technique. No enhancement of tracheobronchial clearance could be detected.Sauna has been shown to cause significant though transient improvement in FEVy in patients with chronic airflow obstruction.' It is also thought to help subjects to acclimatise to rapid temperature changes and to have a bronchodilator effect. The rehabilitation programme for patients with pulmonary diseases in the university lung centre at Nijmegen included the regular use of sauna, and many patients with chronic bronchitis and abundant sputum production indicated that expectoration seemed to be improved during or after it.As sauna might provide an alternative to physiotherapy as an aid to the clearance of excessive bronchial secretions, a study was performed to assess its effect on tracheobronchial clearance in patients with chronic bronchitis. were performed during this period. After completion of the sauna tracheobronchial clearance was measured for about two hours. Measurements on the day with no sauna provided a control. To was defined as the time of the first measurement, from 10 to 30 minutes after inhalation of the radioaerosol. On the control day To was the same length of time after the inhalation as on the sauna day for each patient, to minimise the intrasubject variability in the number of counts at the beginning of the retention curve. Tracheobronchial retention is expressed as the percentage of the corrected activity measured at To.The sauna programme included two identical cycles. Each cycle began with a hot shower followed by 10 minutes in the hot cabin (air temperature about 90'C, relative humidity about 15%). The subject then had a cold 100

Twenty-eight unselected patients with histologically proven aplastic anaemia were electively treated with anabolic steroids (75-150 mg orally q.d.) Additional supportive treatment with blood cell components and antibiotics was given if indicated. Response to therapy was defined as favourable if after 3 months of anabolic therapy overt bleeding tendency had disappeared, there was no need for transfusion therapy, a spontaneous increase of haemoglobin had occurred of greater than 3 g/dl above the initial level, and a platelet rise of twofold the initial count (up to at least greater than 30 x 10(9) /L) had occurred. Of 22 patients evaluable for the results of long-term (greater than 3 months) anabolic treatment, six showed a partial response and eleven responded favourably. These 11 are all alive at the end of the study. Five of these patients proved to be anabolic steroid-dependent. The 50% actuarial survival is approximately 4 years after diagnosis, which compares favourably with the best published results from bone marrow transplantation for aplastic anaemia. It is concluded that anabolic therapy in aplastic anaemia should be tried for 2-3 months before the bone marrow transplantation or immunosuppressive therapy is taken into consideration.

Tracheobronchial clearance was measured twice in 10 healthy non-smoking volunteers to evaluate inter- and intrasubject variability, using a radio-aerosol technique (5 μm ^99mTc-labelled polystyrene particles). By means of two detectors radioactivity in the lungs was measured at regular intervals for 6 h and once more 24 h after inhalation. The decrease in radioactivity after correction for background activity, isotope decay and 24-hour retention was assumed to reflect tracheobronchial clearance. Among other parameters to quantitate the results of these tests, the area under the retention curve up to 6 h after inhalation (AUC-6) was calculated. The intersubject coefficient of variation (COV) using the AUC-6 was 31 %. The intrasubject COV of the AUC-6 was 11 %. These results compare favourably with those reported by others using different techniques. It is concluded that the intrasubject variability of tracheobronchial clearance as measured by this technique is small.

A case of amiodarone pulmonary toxicity (APT) is described following a low dosage of amiodarone (200 mg/day) with serious respiratory insufficiency in a patient after right pneumonectomy. The patient was successfully treated by discontinuation of amiodarone, mechanical ventilation and prednisolone (40 mg/day). A literature study indicates that APT is a dose related toxicity. In our opinion a higher pulmonary drug concentration of amiodarone could exist from a change in pharmacokinetics because of a low fat storage in a thin patient and compensatory growth of the remaining lung which occurs after pneumonectomy. Given these findings we suggest that if amiodarone is indicated in such patients both loading and maintenance doses should be adapted.