Peritoneal TB, whilst otherwise relatively uncommon, is an important manifestation of TB in CAPD patients and usually develops soon after commencing dialysis. The reasons for this are unknown and require further research.

There is wide variation in the availability of EDS for AECOPD in the UK, with increasing implementation of schemes. Thirty percent of patients can effectively be put into EDS which is higher than the figure of 25% from randomised controlled trials (RCTs). Mortality and readmission rates are the same as for units where no EDS is available and similar to results reported in RCTs. EDS therefore appears to be effective in routine clinical practice.

Patients with chronic renal failure (CRF) have a high incidence of tuberculosis (TB). Those from the Indian subcontinent are at particular risk. The frequency of side-effects associated with antituberculous treatment in a group of patients with CRF was studied. All cases of TB in patients with CRF occurring over a 13-yr period at the Manchester Royal Infirmary, from 1986-1999, were identified by diagnostic coding, microbiology records and a TB database. The case notes were then reviewed. Twenty-four cases were identified, eight predialysis and 16 requiring regular dialysis. TB occurring in the dialysis group was extrapulmonary in every case. Nineteen of 24 (79%) patients were of Indian subcontinent origin and 14 of 16 (87%) dialysis patients were non-Caucasian. Adverse effects of treatment occurred in two of eight (25%) in the predialysis group and nine of 16 (56%) of the dialysis group. These were most commonly neuropsychiatric (6), hepatic (4) and gastrointestinal (4). Neuropsychiatric symptoms occurred exclusively in dialysis patients. In conclusion, a high incidence of side-effects from antituberculous medication, especially neuropsychiatric, hepatic and gastrointestinal, was identified in patients with chronic renal failure. Careful monitoring for side-effects is essential in this group, and consideration should be given to administering antituberculous chemoprophylaxis to all high-risk groups. Eur Respir J 2002; 20: 440-443. Patients with chronic renal failure (CRF) have a high incidence of tuberculosis (TB), possibly due to a decrease in cellular immunity [1-4]. Treatment of TB in CRF may be complicated by an increased risk of toxicity from antituberculous drugs, particularly isoniazid and ethambutol. Current British Thoracic Society (BTS) guidelines lack explicit recommendations for the management of these patients [5]. The Manchester Royal Infirmary (MRI) has a large renal unit with dialysis facilities and a catchment population that includes a high proportion of non-Caucasians, especially from the Indian subcontinent. In this study, all cases of TB occurring in patients with pre-existing CRF over a 13-yr period at the MRI were reviewed. Methods CRF can be defined as an irreversible deterioration of kidney function occurring usually over a period of years. Between 1986-1999, cases of TB in patients with CRF were identified by three methods: medical outpatient coding, microbiology records and the respiratory department TB database. For the purpose of this study, a case of TB was considered to be any patient receiving a course of antituberculous chemotherapy, regardless of whether the diagnosis was based on clinical suspicion or microbiological results. Adverse effects were defined as symptoms and/ or signs thought to be due to antituberculous treatment and of sufficiently serious or severe nature to warrant an alteration in therapy. Patients9 case notes were then inspected and relevant data recorded. All patients were treated at the same institution (MRI) for both CRF and TB. Results Twenty-four cases we...

A practical prescribing course can help prepare medical students by giving them the tools to tackle complex prescribing scenarios. Pharmacists as teachers were well received, and specific topics, including controlled drug prescribing and using sample drug charts, should be the focus of these types of courses.

Background: Short burst oxygen therapy (SBOT) is widely prescribed in the UK with little evidence of benefit. A study was performed to examine whether SBOT benefits patients when undertaking normal activities at home among those who already use it. Methods: Twenty-two patients with chronic obstructive pulmonary disease (COPD) were included in the study. All regularly used SBOT at home and claimed that it helps them. Each patient chose two daily living activities for which they used SBOT for relief of breathlessness. Patients were then randomised to use either an air or oxygen gas cylinder. At least 15 min later the same activity was performed using the other gas cylinder. The same process was then repeated for the second chosen activity. The main endpoints were subjective and objective times to recovery, analysed for each activity separately or taking the average over the two activities. A paired statistical analysis was performed. Results: All patients used SBOT with nasal prongs after exercise. Using the average recovery time over two activities for each patient, the mean objective recovery time was 38 s lower (95% CI 281 to +5) using oxygen and the mean subjective recovery time was 34 s lower (95% CI 269 to +2). Five patients were correctly able to distinguish oxygen from air after both activities and there was a suggestion that their recovery times were shorter than those who did not correctly identify the gases (91 s vs 20 s using objective recovery times, and 80 s vs 22 s using subjective recovery times), although this was a subgroup analysis based on only five patients with non-significant results. Conclusions: There is some evidence that SBOT shortens recovery time after activities of daily living in a selected group of patients with COPD, but the effect is small. There appears to be a subgroup of patients who may benefit to a much greater degree.

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Metastasis to the lung occurs quite commonly from certain types of extrapulmonary primary carcinoma. Spread to the bronchial lumen is relatively rare. When this does occur, symptoms resembling those of primary bronchial carcinoma are often present, in association with partial or complete obstruction of the bronchial lumen. Palliation of such symptoms is possible with the use of intraluminal radiotherapy (ILT). Between 1990 and 1998, 37 patients with endobronchial metastases were treated using this modality; a single fraction of radiation was delivered by the remote afterloading high dose rate microSelectron system. Data regarding these patients' characteristics and outcome are presented, following a retrospective review of case notes. The commonest symptoms were dyspnoea, cough and haemoptysis; the commonest primary tumour sites were breast, colorectum, oesophagus and kidney. Twenty-four (64.9%) patients had some improvement in symptoms following treatment. Mean overall survival was 280 days, range 9-1145 days. No serious adverse effects occurred. ILT is a relatively simple, safe and effective treatment in the palliation of symptoms due to endobronchial metastases.

Conclusions Immigrants have a high prevalence of LTBI but current NICE guidance detects only 38.2% of new entrants with LTBI. Given the high rates of reactivation of LTBI in new entrants, our findings suggest that consideration should be given to reducing the screening threshold to include those from the Indian Subcontinent (incidence 170/100 000) which would result in 67.8% of all LTBI cases being identified.