The Effects of Combined Intravenous and Inhaled Steroids (Beclomethasone Dipropionate) for the Emergency Treatment of Acute Asthma

Objective : To compare the efficacy of high-dose inhaled steroids in conjunction with IV steroids with that of IV steroids alone in the emergency treatment for acute asthma.
Methods : A double-blind, placebo-controlled, randomized trial was conducted on 60 ED patients presenting with acute asthma. All patients received nebulized salbutamol, and IV methylprednisolone, 80 mg at baseline and 40 mg at 6 hours. In addition to the above therapy, the experimental group received beclomethasone dipropionate (BDP) 7 mg over 8 hours via a metered-dose inhaler (MDI) attached to a holding chamber, while the control group received a placebo administered in the same fashion. Patients were treated on the protocol for 12 hours with the primary outcome measure being the change in % predicted FEV₁.
Results : Of 60 patients, 30 were randomized to BDP (age: 42 ± 16 years; FEV₁: 0.97 ± 0.42 L) and 30 were randomized to placebo (age: 37 ± 18 years; FEV₁: 0.98 ± 0.35 L). Spirometry and dyspnea measured by the Borg Scale improved significantly in both groups compared with baseline (p < 0.001). Changes in spirometry measures, dyspnea, and vital signs did not differ between treatment groups over the 12 hours of study (p > 0.05).
Conclusion : Inhaled BDP added to the standard regimen of IV methylprednisolone, and β-agonist did not further improve flow rates or dyspnea scores measured for up to 12 hours after presentation to the ED.     

An inhibitory effect of veratridine during tetanic stimulation of the rat diaphragm

The membrane ‘labilizer’ veratridine (3.7 ± 10^-6 m) which potentiates the contractions at twitch (0.1 Hz) stimulation due to multiple discharges, inhibited the tetanic contractions (50 Hz in 10 s) and the simultaneously recorded electromyogram in a use-dependent way, leading to fading of tetanic tension. The effect was equal during indirect and direct stimulation, and could therefore be localized to the excitable sarcolemma. This was confirmed by intracellular recording of action potentials, showing a marked veratridine-induced fallout of action potentials during continuous 50 Hz stimulation, whereas endplate potentials were unaffected. Accordingly, veratridine probably caused a use-dependent inhibition of the Na⁺ channels of the excitable sarcolemma. The tetanic fade was unaffected by K⁺ depolarization, increased by hyperpolarization in K⁺-free solution, and decreased by high Ca²⁺. All these changes of the ionic concentrations inhibited the twitch potentiating effect of veratridine. Since hyperpolarization and increasing the electric field in the membrane with high Ca^,+ had opposite effects on the tetanic fade, the field change was probably not the cause of the antagonism in high Ca²⁺. Instead, a membrane stabilizing effect of high Ca²⁺ is suggested, since the neutral local anaesthetic benzocaine (1.5 ± 10^-4 m), which is also a membrane stabilizing drug, had the same effects as high Ca²⁺ on the veratridine-induced tetanic fade. The effect of veratrine during tetanic stimulation was partly reversible upon washing. The reversibility was enhanced by high Ca²⁺ or benzocaine.     

Magnetic resonance imaging of cerebrotendinous xanthomatosis

Cerebrotendinous xanthomatosis is a rare familial sterol storage disease with accumulation of cholestanol and cholesterol particularly in xanthomas, bile and brain. Magnetic resonance imaging is a useful modality for imaging the affected tissues. It contributes to the evaluation and management of the disease.     

Bone marrow transplantation for refractory acute leukemia in 34 patients with identical twins

Thirty-four patients aged 4-67 yr (median 17) with acute lymphocytic leukemia (ALL) (18 patients) or acute nonlymphocytic leukemia (ANL) (16 patients) who failed to enter complete remission (CR) or relapsed on conventional chemotherapy were treated with cyclophosphamide (CY), 60 mg/kg/day for 2 days, 1000 rad total body irradiation, and a marrow transplant from a genotypically identical normal twin. Sixteen of the patients received additional chemotherapy within the week before CY. After the transplant, 23 patients received immunotherapy consisting of killed autologous leukemic cells and/or normal twin peripheral blood lymphocytes, 16 as part of a prospectively randomized study. One moribund patient died before engraftment. Nine patients (6 ALL, 3 ANL) continued to have detectable leukemic cells. Twenty-four patients (70%) achieved CR. One of them died of viral hepatitis at 1 mo and another of viral interstitial pneumonitis at 4 mo in CR. Fourteen patients (7 ALL, 7 ANL) relapsed 2-16 mo (median 4) after transplantation. However, 8 patients (24%) (3 ALL, 5 ANL) remain in CR without any maintenance chemotherapy at 29-103 mo (median 80) after the transplant. The end results were not signficantly influenced by the type of leukemia, the immediated pre-CY chemotherapy, or the immunotherapy. The results show that this approach, even when applied to endstage patients with acute leukemia in relapse, causes tolerable morbidity, rare nonleukemic deaths, and frequent remissions, some of which represent cures.     

Clinical Evaluation of Atrial Synchronous Ventricular Inhibited Pacemakers

The technical specifications and the operation of two atrial synchronous ventricular inhibited (ASVIP) pacemaker designs are described along with the results of clinical evaluation of these pacemakers in 30 patients. Clinical advantages of such pacemakers are contrasted with the performance of A-V sequential (DVI) and atrial synchronous (VAT) systems.