Background -Autogenic drainage has been suggested as an alternative method of chest physiotherapy in patients with cystic fibrosis. In this study autogenic drainage was compared with the active cycle of breathing techniques (ACBT) together with postural drainage. Methods -Eighteen patients with cystic fibrosis took part in a randomised two-day crossover trial. There were two sessions of one method of physiotherapy on each day, either autogenic drainage or ACBT. The study days were one week apart. On each day the patients were monitored for six hours. Mucus movement was quantified by a radioaerosol technique. Airway clearance was studied qualitatively using xenon-133 scintigraphic studies at the start and end ofeach day. Expectorated sputum was collected during and for one hour after each session of physiotherapy. Pulmonary functions tests were performed before and after each session. Oxygen saturation (Sao,) and heart rate were measured before, during, and after each session. Results -Autogenic drainage cleared mucus from the lungs faster than ACBT over the whole day. Both methods improved ventilation, as assessed by the xenon-133 ventilation studies. No overall differences were found in the pulmonary function test results, but more patients had an improved forced expiratory flow from 25% to 75% with autogenic drainage, while more showed an improved forced vital capacity with ACBT. No differences were found in sputum weight and heart rate, nor in mean Sao, over the series, but four patients desaturated during ACBT. Conclusions -Autogenic drainage was found to be as good as ACBT at clearing mucus in patients with cystic fibrosis and is therefore an effective method of home physiotherapy. Patients with cystic fibrosis should be assessed as to which method suits them best. (Thorax 1995;5O:165-169)

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The oedema which forms around an intracerebral haemorrhage has a complex aetiology. The Spontaneous intracerebral haemorrhage is a significant cause of mortality and morbidity.' Brain oedema secondary to the haemorrhage is a major clinical problem which often proves refractory to treatment. In experimental models the brain oedema that develops after intracerebral haemorrhage is, in part, due to ischaemia.25 Brain oedema has also been shown to follow the inflation of a 50 pl balloon in a model which simulates the mechanical component of a rapidly expanding mass in the rat caudate nucleus.6Attention has recently focused on the role of the cellular constituents of blood in generating cerebral oedema. This can be considered from two points of view: firstly, the direct effect of the cellular constituents within the haematoma, and secondly, the influence of circulating red cells, leucocytes, and platelets on the development of ischaemic oedema. With the first consideration in mind, Jenkins et al have shown that stereotactic injection of autologous blood into the basal ganglia of rats produces greater ischaemia than an equal volume of inert oil of cerebrospinal fluid.2 Suzuki and Ebina, in a similar experiment on dogs, have shown that the volume of oedematous brain is greater after injection of blood than after injection of an inert oil.7 Both ischaemia and oedema are therefore not merely a result of the mass effect of the haematoma but are dependent on other factors inherent within the blood inside the haematoma.With regard to the second mechanism, neutrophils and platelets have been shown to

The effect of global immunosuppression by sublethal whole body X-irradiation on the development of cerebral oedema was assessed 24 h after right middle cerebral artery occlusion in the rat. Irradiation produced a significant leukopenia and thrombocytopaenia, and significantly reduced cortical oedema when compared to non-irradiated control animals.

During a one-year period 53 patients were referred for the investigation of epiphora. All underwent bilateral dacryoscintigraphy. Following the isotope study the patients had either bilateral or unilateral macrodacryocystography; a total of 66 tear ducts were shown by this procedure. The scintigraphs were more sensitive for obstruction (51/66 systems or 77%) than radiography (33/66 systems or 51%). Normal dacryoscintigraphy was always associated with duct patency on dacryocystography. We have concluded that scintigraphy should always be the first investigation and that, if this is normal, radiography is not necessary. The use of digital subtraction imaging for the lacrimal passages is discussed. It is suggested that this may provide information obtained at present only by combining dacryoscintigraphy with conventional contrast radiography.