Comparative study of Astemizole—A new H1 antagonist with a conventional antihistaminic in patients with allergic rhinitis

A double blind study to evaluate in allergic rhinitis the efficacy of Astemizole with a classical antihistaminic—Chlorpheneramine is described. The results indicate that there is a significantly better clinical improvement with Astemizole compared with Chlorpheneramine. Except of weight gain, adverse Cholinergic and sedative effects were also minimal with Astemizole.     

Discrepancies between cerebral perfusion and metabolism after subarachnoid haemorrhage: a magnetic resonance approach

INTRODUCTION—There is a variable relation betweenangiographic vasospasm and delayed ischaemic neurological deficit(DIND). Magnetic resonance (MR) techniques have the potential toinvestigate the haemodynamic, metabolic, and structural changesoccurring with these complications. These techniques have been appliedto study DIND in patients recovering from subarachnoid haemorrhage.
METHODS—Fifteen studies were performed on 11 patients, 10 with DIND. Vasospasm was diagnosed angiographically orwith transcranial Doppler. The MR protocol consisted of T2 weightedimaging, contrast enhanced dynamic perfusion scanning, TI weightedimaging, and two dimensional localised proton spectroscopy. Relativecerebral blood volume maps were generated from perfusion scans.Metabolite ratios were calculated from proton spectra.
RESULTS—All patients had cortical oedema onT2 weighted images, significantly more pronounced in patients of poorclinical grade (p<0.01). Spectra were normal in good grade patients.Lactate was increased and N-acetyl aspartate decreased in the poorgrades, significantly worse in grade 4 compared with grade 3 patients(p<0.05). Spectral changes also correlated with the severity of oedema(p<0.05). Relative blood volumes were significantly higher inoedematous regions of poor compared with good grade patients (p<0.05).Lactate was seen in regions of the brain with increased relative blood volume.
CONCLUSIONS—Despite the paramagnetic effects ofhaemorrhage, or of the coils and clips used to treat aneurysms, thisstudy demonstrates that patients recovering from subarachnoidhaemorrhage can undergo complex MR studies. Oedema, lactate, andincreased relative blood volume correlate well with each other and withDIND and poor clinical grade.

     

Assessment of fitness in patients with cystic fibrosis and mild lung disease

BACKGROUND: Maximal exercise testing is used in patients with cystic fibrosis to assess functional status and prognosis. The lactate threshold is an index of aerobic fitness with significant advantages over maximal exercise tests. This study was undertaken to determine if the lactate threshold might be identified, non-invasively, in adult patients with cystic fibrosis and mild lung disease by measurement of ventilatory and gas exchange parameters. METHODS: Ten subjects with mild cystic fibrosis (forced vital capacity (FVC) > 70% predicted) and 10 healthy controls undertook an incremental exercise test on a bicycle ergometer. Ventilation and gas exchange parameters were measured continually and arterialised venous blood pH, carbon dioxide tension (PCO2), and lactate concentrations were measured at intervals throughout the tests. RESULTS: In subjects with cystic fibrosis there was no significant difference between the mean gas exchange and lactate thresholds (mean difference 1.0 (95% confidence interval (CI) of the mean -1.5 to 3.44) ml/kg/min). In contrast, there was a significant difference between the mean ventilatory and lactate thresholds (3.8 (95% CI 0.9 to 6.7) ml/kg/min). Arterialised venous PCO2 increased significantly during the exercise tests. In healthy subjects the mean differences between these thresholds were not significantly different from zero and PCO2 fell significantly during the tests. CONCLUSIONS: The ventilatory threshold significantly overestimates the lactate threshold in subjects with cystic fibrosis induced lung disease because of impaired carbon dioxide excretion during exercise. However, the gas exchange threshold may be used to determine the lactate threshold in this patient group.


     

Meal area index: a new technique for quantitative assessment in achalasia by ambulatory manometry during eating.

Ambulatory non-perfused oesophageal manometry was used to study oesophageal body function during consumption of a full meal in patients with achalasia. A measure of oesophageal body activity (the meal area index) was developed by calculating the total area under the pressure curve during eating, above the preprandial baseline oesophageal pressure, per meal minute. Untreated patients with achalasia (n = 13) were compared with normal subjects (n = 42), patients with benign stricture (n = 9) and patients with achalasia who had undergone Heller's myotomy (n = 17). The results showed a high meal area index in achalasia, due to a rise in baseline oesophageal pressure and frequent high-amplitude contractions during eating. This was not seen in normal subjects or patients with stricture. The high meal area index was abolished by successful Heller's myotomy but remained in two patients with persisting dysphagia. Sustained high intraoesophageal pressure is generated during consumption of a solid meal in untreated achalasia, resulting in a unique manometric profile. Manometry during eating using the meal area index permits quantitative assessment of oesophageal body function in achalasia and may aid in the assessment of response to treatment.     

Combined effect of body position, apparatus and distraction on children's resting metabolic rate.

OBJECTIVE: To verify the combined effect of body position, apparatus and distraction on children's resting metabolic rate (RMR). METHODS: Experiments were carried out on 14 children aged 8-12 (mean age = 10.1 years +/- 1.4). Each participant underwent two test sessions, one week apart under three different situations: a) using mouthpiece and nose-clip (MN) or facemask (FM); b) sitting (SEAT) or lying (LY); and c) TV viewing (TV) or no TV viewing. In the first session, following 20 min rest and watching TV, the protocol was: LY: 20 min stabilization; 10 min using MN and 10 min using FM. Body position was then changed to seated: 20 min stabilization; 10 min using FM; 10 min using MN. In the second session, FM and MN order was changed and participants did not watch TV. Data were analysed according to the eight combinations among the three studied parameters. RESULTS: Repeated measures ANOVA indicated statistically significant differences for VO2 (p =0.01) and RMR (p =0.02), with TVMNSEAT showing higher values than TVFMLY. Bland-Altman analysis showed a bias for VO2, VCO2, respiratory quotient (RQ) and RMR between TVFMLY and TVMNSEAT, respectively, of -17.8+/-14.5 (ml min), -8.8+/-14.5 (ml min), 0.03+/-0.05 and -115.2+/-101.9 (kcal/day). CONCLUSION: There were no differences in RMR measurements due to body position and apparatus when each variable was isolated. Analyses of distraction in three of four combinations indicated no difference between TV and no TV. Different parameter combinations can result in increased bias and variability, and thereby the reported differences among children's RMR measurement.