The algorithms utilised in the diagnosis of chronic cough advocate sequential investigations and treatment trials for asthma-like syndromes, post-nasal drip and gastrooesophageal reflux disease; however, the role of bronchoscopy is unclear. In the present authors' specialist clinic (North West Lung Centre Cough Clinic, Manchester, UK), flexible bronchoscopy is included in the diagnostic work-up of patients with chronic unexplained cough. In a retrospective review, the authors report on their experiences.Over an 18-month period, patients followed a diagnostic algorithm that included: chest radiography; pulmonary function; methacholine challenge; ear, nose and throat examination; and empirical reflux treatment. Where diagnosis remained elusive, bronchoscopy was performed.A total of 82 bronchoscopies were carried out for the sole indication of chronic cough. Patient age (mean¡SD) was 54.9¡11.22 yrs, with a median (range) cough duration of 5 (0.5-30) yrs. In nine (11%) subjects, a diagnosis was made on inspection or biopsy. These included seven cases of tracheobronchopathia osteochondroplastica (TPO), one case of elongated uvula and one case of endobronchial amyloidosis. All TPO patients had early changes, with a typical nodular appearance to the tracheal cartilage, without significant airway obstruction. These subtle changes could not have been predicted from less invasive procedures and would have been missed without bronchoscopy.Flexible bronchoscopy is indicated in persistent unexplained cough and may reveal contributing pathology.

SUMMARY The concentration of cortisol and cortisone in mixed saliva has been measured in normal non-pregnant women, normal pregnant women in the third trimester of pregnancy and pregnant ones with mild toxaemia in the third trimester. The ratio of cortisol to cortisone was 1:4 for the non-pregnant and 1:5 for the pregnant women. The mean concentration of cortisol for the pregnant subjects was twice that of the non-pregnant and the mean concentration of cortisone three times that of the non-pregnant women. Filtration studies showed no significant binding of cortisol or cortisone in the saliva. It is concluded that the raised concentration of cortisol and cortisone in saliva indicates a raised concentration in the cells of the salivary gland. If this rise is common to the connective tissues generally it provides a reasonable explanation for the remission of rheumatoid arthritis experienced by some patients in the latter months of pregnancy.

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Sulphasalazine is an effective treatment for rheumatoid arthritis but the response in any individual is unpredictable. We have sought to establish a relationship between dose (in mg/kg body weight) and metabolism of the drug in 79 patients selected for an extremely good response (43) or no response (36) to treatment with sulphasalazine. The dose of sulphasalazine in relationship to body weight showed no difference between the two treatment outcome groups. The distribution of acetylator phenotype showed only a trend for slow acetylators to occur more frequently in the group of good responders to treatment. There is no advantage in the routine assessment of acetylator phenotype as a predictor of response to treatment with sulphasalazine.

We describe a quantitative method for determination of histidine and 16 other amino acids in a nail hydrolysate. This is based on the formation of trifluoroacetyl amino acid methyl esters and gas-liquid chromatographic analysis with use of two columns of mixed stationary phases. Histidine is determined as a triple derivative Nalpha-trifluroacetyl-Nim-carbethoxy methyl histidinate. The specificity and reproducibility of the method are illustrated. As little as 1 mg of amino acid per gram of nail can be determined, and 15 hydrolysates can be completely analyzed in 10 working days. Data obtained from multiple analyses of 10 nail hydrolysates by the method described closely parallel those obtained in another laboratory, in which an amino acid analyzer was used.