Iron overload, which is a common complication in haemodialysis patients, is known to enhance bacterial growth and virulence, and to alter phagocytosis. We reviewed the data of 61 haemodialysed patients to clarify the clinical relevance of iron status to the risk of bacterial infection. Increased concentrations of serum ferritin were associated with a greater infection rate (P less than 0.0025), which was already true for ferritin values between 500 and 1000 micrograms/l (P less than 0.025). Furthermore, in 21 iron-overloaded patients treated with an iron-chelator (desferrioxamine), the infection rate decreased from 1/19 patient-months to 1/112 (P less than 0.005), and returned to previous values when desferrioxamine was stopped. Our results demonstrate the importance of haemosiderosis in the increased susceptibility of haemodialysed patients to infections; this susceptibility is decreased by desferrioxamine therapy, which probably acts by restoring phagocytosis and reducing the bioavailability of iron for pathogens.

P Pl le eu ur ra al l e ef ff fu us si io on n d du ur ri in ng g b br ro om mo oc cr ri ip pt ti in ne e e ex xp po os su ur re e i in n t tw wo o p pa at ti ie en nt ts s w wi it th h p pr re e--e ex xi is st ti in ng g a as sb be es st to os s p pl le eu ur ra al l p pl la aq qu ue es s: : a a r re el la at ti io on ns sh hi ip p? ? ABSTRACT: Two patients with pleural plaques developed pleural effusion and subsequent diffuse pleural fibrosis 50 and 39 yrs after their first exposure to asbestos. The diagnosis of benign asbestos pleural effusion was suggested, but the work-up finally suggested bromocriptine-induced pleural disease in both patients.These two cases illustrate that drug-induced pleural effusion is an important differential diagnosis of benign asbestos pleural effusion. It is, moreover, possible that pre-existing asbestos pleural lesions, or even asbestos exposure, increases the risk of developing bromocriptine-induced pleural disease.

A case of septicemia caused by Pseudomonas stutzeri belonging to the unusual biotype Vb-3 in a patient with multiple myeloma is described. The origin of the septicemia was attributed to a community-acquired pneumonia. The bacteriology and pathogenicity of P. stutzeri are reviewed. Pseudomonas stutzeri is a ubiquitous gram-negative rod found in soil and water, the hospital environment, and various clinical specimens (7). Some 90 years ago, the bacterium was described as Bacillus denitrificans Il by Burri and Stutzer, who found the organism in soil, manure, canal

No abstract

Background -A study was undertaken to evaluate the reliability of a digital tracheal sound analyser (ELENS-DSA) in predicting nocturnal changes in airways resistance in asthmatic patients. This device allows continuous measurement of the proportion ofthe time occupied by wheezing (Wh%). Methods -Nocturnal polygraphic studies with simultaneous continuous monitoring of tracheal sounds and airways resistance were performed in seven patients with nocturnal asthma. In order to evaluate the possible bias in wheezing estimation, each tracheal sound recording was passed through the automatic analyser and simultaneously monitored with earphones by an experienced observer. Results -The device detected audible wheezing with an optimal sensitivity and specificity of 70%. Snoring was a minor cause of the relatively poor characteristics ofthe system. A close correlation (p<0-001) between Wh% and airways resistance was observed only in those patients with the highest increase in resistance; when the results of all the subjects were pooled the correlation observed was poor. The predictive value of Wh% in detecting changes in airways resistance during 10 minute intervals was lower than 70%. The positive and negative predictive values of Wh% were raised to 79% and 83%, respectively, for 30 minute intervals. Conclusions -The ELENS-DSA system is a relatively crude means of detecting wheezing and assessing bronchoconstriction quantitatively. However, it is able to detect accurately nocturnal bronchoconstriction for 30 minute intervals. This finding, along with the fact that the monitoring is non-invasive, suggests that it may be a promising tool, especially for patients during sleep. (Thorax 1996;51:694-698)