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Alterations in intestinal permeability reflect one component of intestinal epithelial barrier function. The objective of this study was to assess the degree of derangement of intestinal permeability in critically ill patients and to investigate the relationship of this to markers of disease severity and sepsis. Sixteen patients admitted to the intensive care unit for a variety of problems were studied with the severity of illness and degree of sepsis recorded daily. A differential sugar absorption test, using lactulose and mannitol as markers, was performed, and in 10 patients this was repeated after an interval of between 4-11 days. The use of the lactulose/mannitol (L/M) ratio corrects for variables unrelated to permeability such as gastric emptying. The L/M ratio was significantly higher in patients (median 0.98) compared to normal controls (median 0.008). The ratios showed no relation to disease severity or sepsis. These results establish that increased intestinal permeability occurs in the general ICU patient but that it is not uniquely related to sepsis. The extent of this abnormality suggests that further study is required to show the various influences on this process.

This paper reports a successful experimental attempt to increase satisfaction with communications amongst general medical patients. A group of patients who received extra interviews designed to increase their understanding of what they had been told about their illnesses showed significantly greater satisfaction than patients treated in the usual manner, and patients who received extra placebo interviews about their hospital stay. Changes in satisfaction with communications over the period following discharge from hospital are also described and possible reasons for them are discussed.

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The procedure produced a rise in effective static compliance from a mean of 17 (SD 6) ml/cm H20 to 24 (9) ml/cm H20 at four hours. Bronchial lavage was associated with a significant excess of respiratory infections. A feature common to most patients was undertreatment before admission to hospital.Although the hospital mortality from acute severe asthma is less than 1% 1 mechanical ventilation (intermittent positive pressure ventilation: IPPV) is life saving in a few patients. We have reviewed the efficacy and safety of IPPV and therapeutic bronchial lavage in the management of acute severe asthma in a district general hospital. Furthermore, we have analysed the pattern of asthma before IPPV in an attempt to identify preventable factors.