Objective. To investigate the association between primary systemic vasculitis (PSV) and environmental risk factors.Methods. Seventy-five PSV cases and 273 controls (220 nonvasculitis, 19 secondary vasculitis, and 34 asthma controls) were interviewed using a structured questionnaire. Factors investigated were social class, occupational and residential history, smoking, pets, allergies, vaccinations, medications, hepatitis, tuberculosis, and farm exposure in the year before symptom onset (index year). The Standard Occupational Classification 2000 and job-exposure matrices were used to assess occupational silica, solvent, and metal exposure. Stepwise multiple logistic regression was used to calculate the odds ratio (OR) and 95% confidence interval Conclusion. A significant association between farming and PSV has been identified for the first time. Results also support previously reported associations with silica, solvents, and allergy.The primary systemic vasculitides (PSV) are a group of relatively rare diseases of unknown etiology (1). A number of potential environmental risk factors have been reported. Systemic vasculitis has been associated with exposure to particulate silica (e.g., quartz, granite, sandstone, and grain dust) (2-5). There has been conflicting evidence regarding a link between occupational exposure to hydrocarbons (e.g., paints, glues) and Wegener's granulomatosis (WG) and microscopic polyangiitis (MPA), and the association with glomerulonephritis is stronger (6-8). A case-control study carried out at the National Institutes of Health (NIH) revealed an association with exposure to fumes or particulates and pesticides in patients with WG compared with healthy or rheumatic disease controls but not respiratory disease

To determine whether sputum clearance is increased by using nebulised saline or terbutaline as an adjunct to chest physiotherapy, a radioaerosol method (using technetium-99m labelled human albumin millimicrospheres) was employed in eight patients with stable bronchiectasis on four occasions, for comparison of sputum clearance with four different regimens. These were: control, with the patient resting in an upright position; chest physiotherapy, by the forced expiration technique with postural drainage; and chest physiotherapy following five minutes' inhalation of either nebulised normal saline or nebulised terbutaline 5 mg. Use of both nebulised saline and nebulised terbutaline immediately before chest physiotherapy gave a significantly greater yield of sputum than did physiotherapy alone, and terbutaline also significantly increased radioaerosol clearance from the whole lung and from regions of interest. The mechanism is unclear, but this method may provide a simple way of increasing the efficacy of conventional chest physiotherapy.Chest physiotherapy is widely used in hospital practice but there is little objective assessment of its value in different settings. A central function of chest physiotherapy in acute conditions is to mobilise excess secretions and enhance expectoration.' The use of an inhaled radio aerosol that is deposited on the tracheobronchial tree allows such secretions to be "labelled" and their subsequent clearance monitored. Use of this method has shown the contribution of cough,2 vibration, or percussion3 to clearance to be limited; greater clearance of airways secretions is obtained by the forced expiration technique in conjunction with postural drainage.45 We have evaluated the use of nebulised saline and nebulised terbutaline as an adjunct to this optimal chest physiotherapy to determine whether sputum clearance is increased further. MethodsWe studied eight patients (six of them women), aged 36-71 years, with stable bronchiectasis on four occasions. Their mean daily sputum production was 36 (range 10-120) g. The results of spirometry before Address for reprint requests: Dr P P Sutton, Hartlepool General Hospital, Hartlepool, Cleveland TS24 9RH. Accepted 10 July 1987 and after each of the four treatment days are shown in the table. No patient smoked, and bronchodilators and domiciliary physiotherapy were withheld on the morning of each study day. PHYSIOTHERAPYThe treatment schedules, given in randomised order, were: (1) control, patient resting upright; (2) chest physiotherapy; (3) chest physiotherapy following five minutes' inhalation of nebulised normal saline; (4) chest physiotherapy following five minutes' inhalation of nebulised terbutaline (5 mg).Chest physiotherapy included the forced expiration technique and postural drainage and lasted for 20 minutes. For treatment 3, 4 ml normal saline was nebulised for five minutes immediately before physiotherapy by a Unicorn jet nebuliser with a mouthpiece and driven by oxygen at 8 1 m-'. For treatment 4, terbutaline respirator solut...

Kaposi's sarcoma (KS) is a highly vascular tumour, which was first described by the Hungarian dermatologist Moritz Kaposi Kohn before the discovery of the human immunodeficiency virus (HIV). Historically, KS has been linked to immunosuppression or to elderly male patients, especially in relation to diffuse cutaneous KS. We describe a case of Bronchopulmonary Kaposi's sarcoma in a patient with AIDS who was successfully treated with HAART and Liposomal Doxorubicin chemotherapy.

Background: Systemic corticosteroids and inhaled β 2 agonists are accepted first line treatments for acute severe asthma, but there is no consensus on their optimum dosage and frequency of administration. American regimens include higher initial dosages of β 2 agonists and corticosteroids than UK regimens. Methods: In a prospective, pragmatic, randomised, parallel group study, 170 patients of mean (SD) age 37 (12) years with acute asthma (peak expiratory flow (PEF) 212 (80) l/min) presenting to hospital received treatment with either high dose prednisolone and continuous nebulised salbutamol as recommended in the US or lower dose prednisolone and bolus nebulised salbutamol as recommended in the UK by the BTS. Results: Outcome measures were: ∆PEF at 1 hour (BTS 89 l/min, US 106 l/min, p=0.2, CI -8 to 41) and at 2 hours (BTS 49 l/min, US 101 l/min, p<0.0001, CI 28 to 77); time to discharge if admitted (BTS 4 days, US 4 days); rates of achieving discharge PEF (>60%) at 2 hours (BTS 64%, US 78%, p=0.04); time to regain control of asthma as measured by PEF >80% best with <20% variability (BTS 3 days, US 4 days, p=0.6); PEF at 24 hours in patients admitted (BTS 293 l/min, US 288 l/min, p=0.8); and control of asthma in the subsequent month (no significant differences). Conclusions: Treatment with higher doses of continuous nebulised salbutamol leads to a greater immediate improvement in PEF but the degree of recovery at 24 hours and speed of recovery thereafter is achieved as effectively with lower corticosteroid doses as recommended in the British guidelines.

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